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Perioperative Management of Anticoagulants

  • Ibrahim M. Ali
  • Alexander Volodarskiy
  • Joe F. Lau
Chapter

Abstract

It is estimated that 250,000 patients who are on anticoagulants undergo surgery annually. Management of anticoagulant and antiplatelet therapies in patients scheduled for surgery is challenging, as the interruption of therapy may increase the risk of thromboembolism, and continuation may predispose patients to increased peri- and intraoperative bleeding risks. It is therefore crucial to conduct an individualized and thorough periprocedural assessment for risk of thromboembolism and bleeding. This chapter will outline the management of warfarin, direct oral anticoagulants, and antiplatelet agents in the perioperative setting. Topics such as short-term parenteral or “bridging” therapy, bleeding risk stratification, and thromboembolic risk stratification will be addressed.

Keywords

Parenteral anticoagulation Perioperative CHA2DS2-VASc HAS-BLED Warfarin Direct oral anticoagulants (DOACs) Antiplatelet Venous thromboembolism (VTE) Arterial thromboembolism (ATE) Atrial fibrillation Prosthetic heart valve 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ibrahim M. Ali
    • 1
  • Alexander Volodarskiy
    • 2
  • Joe F. Lau
    • 3
  1. 1.Department of CardiologyNorthwell Health, Zucker School of Medicine at Hofstra/NorthwellManhassetUSA
  2. 2.Department of CardiologyNew York-Presbyterian/QueensFlushingUSA
  3. 3.Department of CardiologyZucker School of Medicine at Hofstra/Northwell, Northwell HealthManhassetUSA

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