ABSTRACT

The perioperative management of patients on anticoagulant therapy

The number of patients who undergo surgical procedures while receiving anticoagulant therapy increases year by year. The management of anticoagulation in patients undergoing surgery is a great challenge because an interruption to anticoagulation for the duration of a procedure increases transiently the risk of thromboembolism. On the other hand, surgical treatment of patients on anticoagulant therapy distinctly increases the risk of bleeding. This paper discusses the perioperative management of patients on anticoagulants, taking into account the patient’s individual clinical circumstances as well as the type of procedure and its urgency.

Zalecane piśmiennictwo

1. Bienias P, Lisicka M. Leczenie przeciwzakrzepowe w okresie okołozabiegowym u osób starszych. W: Broczek K, Lewandowski M (red.). Zdrowie seniorów – wspólny cel współczesnej kardiologii i geriatrii. Warszawa: Medical Tribune, 2020:207-27

2. Doherty JU, Gluckman TJ, Hucker WJ, et al. 2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: a report of the American College of Cardiology clinical expert consensus document task force. J Am Coll Cardiol 2017;69(7):871-98. doi: 10.1016/j.jacc.2016.11.024

3. Douketis JD, Spyropoulos AC, Kaatz S, et al.; BRIDGE Investigators. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med 2015;373(9):823-33. doi: 10.1056/NEJMoa1501035

4. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141(2 Suppl):e326S-50S. doi: 10.1378/chest.11-2298.

5. Furdyna A, Jankowski K. Zabieg operacyjny u pacjenta z żylną chorobą zakrzepowo-zatorową. W: Pruszczyk P, Ciurzyński M, Kostrubiec M (red.). Żylna choroba zakrzepowo-zatorowa. Wyd. 2. Warszawa: Medical Tribune, 2021:444-53

6. Kristensen SD, Knuuti J, Saraste A, et al.; Authors/Task Force Members. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 2014;35(35):2383-431. doi: 10.1093/eurheartj/ehu282

7. Machowski M, Pruszczyk P. Chorzy leczeni doustnymi lekami przeciwzakrzepowymi niebędącymi antagonistami witaminy K (NOAC) przed zabiegami operacyjnymi planowymi/pilnymi. W: Kuch M, Pruszczyk P, Hryniewiecki T (red.). NOAC w praktyce klinicznej. Warszawa: Medical Education, 2018:187-92

8. Ruohoniemi DM, Sista AK, Doany CF, et al. Perioperative pulmonary thromboembolism: current concepts and treatment options. Curr Opin Anaesthesiol 2018;31(1):75-82. doi: 10.1097/ACO.0000000000000550

9. Steffel J, Collins R, Antz M, et al.; External reviewers. 2021 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021;23(10):1612-76. doi: 10.1093/europace/euab065

10. Tomkowski W, Kuca P, Urbanek T, et al. Venous thromboembolism – recommendations on the prevention, diagnostic approach and management. The 2017 Polish Consensus Statement. Acta Angiologica 2017;23(2):35-71. doi: 10.5603/AA.2017.0008

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