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Peri-procedural Anticoagulation

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Anticoagulation Management

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Abstract

The pharmacist-led medication management of patients receiving anticoagulant therapy in the peri-procedural setting is a common scenario. Patients require careful planning to ensure they receive optimal dosing and monitoring of medications, to avoid potential harm. The use of anticoagulants requires a delicate balance between the risks of procedural bleeding and the risks of thrombosis due to suspension of therapy, particularly in high-risk patients. All anticoagulants have the ability to increase the risk of bleeding. In most cases surgical staff require patients to have a haemostatic state suited to the procedure. Anticoagulants have pharmacological properties that are unpredictable, and inter-patient variability in drug response is high. This means that no one peri-procedural strategy has been universally standardised to suit to all patients, and therefore guidelines are often formalised at a local healthcare level. As a consequence, high-grade evidence is lacking for the dosing and monitoring of anticoagulants in the peri-procedural setting. Multi-disciplinary input is essential to optimise patient care, and pharmacists are in the ideal position to lead effective anticoagulant use in the surgical arena. Competent pharmacists should be experts in the pharmacokinetics of anticoagulants, have the skills to elicit accurate medication histories and construct individualised patient care plans that guide the effective use of anticoagulants.

This chapter outlines the background to peri-procedural anticoagulation, key principles of effective patient care, relevant dosing and monitoring aspects of common anticoagulants, typical bridging plans and the dilemma of emergency surgery. The important role of the pharmacist in the peri-procedural setting is interspersed throughout the chapter and summarised at the end.

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Authors and Affiliations

  1. Pharmacy Department, Royal Brisbane Women’s Hospital, Metro North Hospital and Health Service | Queensland Government, Butterfield St, Herston, QLD, 4029, Australia

    Michael Barras BPharm, Grad Dip Clin Pharm, PhD

  2. School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, QLD, 4102, Australia

    Michael Barras BPharm, Grad Dip Clin Pharm, PhD

  3. School of Pharmacy, Queensland University of Technology, Level 5, Q Block, Brisbane, QLD, 4000, Australia

    Michael Barras BPharm, Grad Dip Clin Pharm, PhD

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  1. Michael Barras BPharm, Grad Dip Clin Pharm, PhD
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Correspondence to Michael Barras BPharm, Grad Dip Clin Pharm, PhD .

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Editors and Affiliations

  1. Madison, Wisconsin, USA

    Anne Rose

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Barras, M. (2015). Peri-procedural Anticoagulation. In: Rose, A. (eds) Anticoagulation Management. Adis, Cham. https://doi.org/10.1007/978-3-319-22602-6_8

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