Periprocedural Management of Oral Anticoagulation

Med Clin North Am. 2020 Jul;104(4):709-726. doi: 10.1016/j.mcna.2020.02.005. Epub 2020 May 12.

Abstract

Decisions surrounding periprocedural anticoagulation management must balance thromboembolic and procedural bleed risk. The interruption of both warfarin and DOACs requires consideration of anticoagulant pharmacokinetics, procedural bleed risk and patient characteristics. There is a diminishing role for periprocedural bridging LMWH overall and no role for bridging LMWH for the procedural interruption of DOACs. A clinical approach to perioperative DOAC management based on operative bleeding risk and renal function is safe and effective, and at present, is preferred over preprocedural DOAC levels testing. Clear communication of the anticoagulation interruption plan to both the patient and the patient's care team is essential.

Keywords: Anticoagulants; Apixaban; Atrial fibrillation; Dabigatran; Perioperative period; Postoperative complications; Rivaroxaban; Warfarin.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Atrial Fibrillation / drug therapy*
  • Dabigatran
  • Hemorrhage / chemically induced
  • Heparin, Low-Molecular-Weight
  • Humans
  • Perioperative Care / adverse effects
  • Perioperative Care / methods*
  • Postoperative Complications / prevention & control
  • Pyrazoles
  • Pyridones
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Risk Factors
  • Rivaroxaban
  • Stroke / prevention & control*
  • Surgical Procedures, Operative / adverse effects
  • Warfarin

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • Pyrazoles
  • Pyridones
  • apixaban
  • Warfarin
  • Rivaroxaban
  • Dabigatran