Abstract
Clinical trials of antithrombotic agents enrolled thousands of patients and form the basis of current recommendations for therapy. However, many patients with thrombosis were not adequately represented in clinical trials. These would include patients at extremes of weight, those with renal disease, those with recent bleeding, and those who need surgery. This chapter reviews many challenging clinical situations such as anticoagulation in those with renal disease and restarting anticoagulation after bleeding. Recommendations are made based on the limited data available.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Suggested Reading
Baharoglu MI, Cordonnier C, Al-Shahi Salman R, de Gans K, Koopman MM, Brand A, Majoie CB, Beenen LF, Marquering HA, Vermeulen M, Nederkoorn PJ, de Haan RJ, Roos YB, Investigators PATCH. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet. 2016;387(10038):2605–13.
Chousou PA, Pugh PJ. Managing anticoagulation in patients receiving implantable cardiac devices. Futur Cardiol. 2018;14(2):151–64.
Devereaux PJ, Mrkobrada M, Sessler DI, Leslie K, Alonso-Coello P, Kurz A, Villar JC, Sigamani A, Biccard BM, Meyhoff CS, Parlow JL, Guyatt G, Robinson A, Garg AX, Rodseth RN, Botto F, Lurati Buse G, Xavier D, Chan MT, Tiboni M, Cook D, Kumar PA, Forget P, Malaga G, Fleischmann E, Amir M, Eikelboom J, Mizera R, Torres D, Wang CY, VanHelder T, Paniagua P, Berwanger O, Srinathan S, Graham M, Pasin L, Le Manach Y, Gao P, Pogue J, Whitlock R, Lamy A, Kearon C, Baigent C, Chow C, Pettit S, Chrolavicius S, Yusuf S, POISE-2 Investigators. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370(16):1494–503.
Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, Garcia DA, Jacobson A, Jaffer AK, Kong DF, Schulman S, Turpie AG, Hasselblad V, Ortel TL, BRIDGE Investigators. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373(9):823–33.
Man-Son-Hing M, Nichol G, Lau A, Laupacis A. Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. Arch Intern Med. 1999;159(7):677–85.
Siontis KC, Zhang X, Eckard A, Bhave N, Schaubel DE, He K, Tilea A, Stack AG, Balkrishnan R, Yao X, Noseworthy PA, Shah ND, Saran R, Nallamothu BK. Outcomes associated with apixaban use in patients with end-stage kidney disease and atrial fibrillation in the United States. Circulation. 2018;138(15):1519–29.
Zhou Z, Yu J, Carcel C, Delcourt C, Shan J, Lindley RI, Neal B, Anderson CS, Hackett ML. Resuming anticoagulants after anticoagulation-associated intracranial haemorrhage: systematic review and meta-analysis. BMJ Open. 2018;8(5):e019672.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
DeLoughery, T.G. (2019). Clinical Dilemmas in Anticoagulation: Extremes of Weight, Renal Disease, Recent Bleeding, and Surgery. In: DeLoughery, T. (eds) Hemostasis and Thrombosis. Springer, Cham. https://doi.org/10.1007/978-3-030-19330-0_28
Download citation
DOI: https://doi.org/10.1007/978-3-030-19330-0_28
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-19329-4
Online ISBN: 978-3-030-19330-0
eBook Packages: MedicineMedicine (R0)