Skip to main content

Advertisement

Advertisement

ADVERTISEMENT

News

Perioperative Anticoagulation Management Should Weigh Thromboembolic, Bleeding Risks

Jolynn Tumolo

Managing patients on anticoagulation treatment during the perioperative period is a challenge that brings with it the risk for major complications, explains a StatPearls continuing education article.

“The interruption of therapy can increase the risk of thrombotic events during and after surgery,” wrote authors Javier J. Polania Gutierrez, MD, of Augusta University Hospital, and Klifford R. Rocuts, MD, of Augusta University, in Augusta, Georgia. “However, the noninterruption of these medications can heighten the risk of bleeding during surgery and trigger a sequence of undesirable outcomes ranging from minor to uncontrolled bleeding.”

The article provides a pharmacological review of anticoagulation agents and considerations to guide health care providers in whether to pause a patient’s anticoagulation and anti-aggregation therapy before surgery.

“These include an evaluation of an individual’s underlying bleeding risk, the risk of bleeding associated with the surgical procedure, the timing of interruption and resumption of anticoagulation therapy, and whether to use bridging therapy,” the authors explained.

Bridging therapy refers to the substitution of a long-acting anticoagulant for a shorter-acting anticoagulant to limit the time of subtherapeutic levels. Bridging therapy is used on a case-by-case basis, although growing evidence suggests limited benefit, if any at all, according to the article.

Specifics on how to use bridging therapy, patient management for various clinical scenarios, and emergency reversal of anticoagulation are also covered in the piece, as is the importance of teamwork for quality patient care.

“Only by working as an interprofessional team can the morbidity and mortality related to anticoagulation treatments and physicians’ errors be diminished,” the authors advised.

Reference

Polania Gutierrez JJ, Rocuts KR. Perioperative Anticoagulation Management. [Updated 2023 Jan 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557590/

Advertisement

Advertisement