Perioperative management of patients with atrial fibrillation receiving anticoagulant therapy

  • Takeshi OmaeEmail author
  • Keito Koh
  • Masateru Kumemura
  • Sonoko Sakuraba
  • Yosuke Katsuda
Review Article


The number of patients with atrial fibrillation (AF) and the number of patients indicated for anticoagulant therapy have been increasing because AF would affect patient survival due to thromboembolism. Once AF develops, following the disappearance of pulsation, the circumstances within the atrium become prothrombotic and thrombus formation within the left atrium occurs in patients with AF. In recent years, not only warfarin but also new oral anticoagulants were introduced clinically and have become used as oral anticoagulants. In the perioperative period, the risk of major hemorrhage needs to be reduced. On the other hand, the suspension of anticoagulant therapy and neutralization of anticoagulant effects elevate the risk of thrombosis. The perioperative management of patients receiving anticoagulant therapy is different from that of scheduled surgery and emergency surgery. In addition, knowledge of the characteristics of each oral anticoagulant is required at drug cessation and resumption. Unlike warfarin, which has been used in the past five decades, direct oral anticoagulants (DOACs) do not have sensitive indicators such as prothrombin time-international normalized ratio. To avoid major hemorrhages and thromboembolism, quantitative assays can be implemented for DOAC monitoring and for reversal therapies in perioperative settings.


Atrial fibrillation Direct oral anticoagulants Hemorrhage Scheduled and emergency surgery Thromboembolism 


Author contributions

Study conception and design: TO. Data acquisition: TO, KK, and YK. Drafting of the article: MK and SS. Critical revision of the article for important intellectual content: TO.

Compliance with ethical standards

Conflict of interest

The authors have no competing interests to declare.


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Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain ClinicJuntendo University Shizuoka HospitalIzunokuniJapan

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