HelixTalk Episode #74 - Taking a break: perioperative management of anticoagulants and antiplatelets, Part I

Date posted: February 20, 2018, 6:00 am

In this episode, we will discuss some important factors to consider in management of various anticoagulants. We will also provide agent specific pharmacodynamic and pharmacokinetic based recommendations.

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Key Concepts

1. In evaluating perioperative anticoagulation, individualization is key!  Consider patient-specific factors when weighing the risks of bleeding against the risks of clotting.
2. The holding period for an anticoagulant depends on its pharmacodynamic and kinetic properties as well as patient-specific factors such as renal function and bleeding risk. 
3. Perioperative anticoagulation is an interdisciplinary affair -- collaborate with surgeons, specialists, an anticoagulant team, the patient or their caregiver, etc. to follow the plan properly and ensure that all parties on the same page. 

References

1. 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-e350S. 
2. 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation. John U. Doherty, Ty J. Gluckman, William J. Hucker, James L. Januzzi, Thomas L. Ortel, Sherry J. Saxonhouse, Sarah A. Spinler. Journal of the American College of Cardiology. 2017; 69(7):871-898.