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Review
. 2020 Jul;104(4):709-726.
doi: 10.1016/j.mcna.2020.02.005. Epub 2020 May 12.

Periprocedural Management of Oral Anticoagulation

Joseph R Shaw  1 , Eric Kaplovitch  2 , James Douketis  3
Affiliations
Review

Periprocedural Management of Oral Anticoagulation

Joseph R Shaw et al. Med Clin North Am. 2020 Jul.

Abstract

Decisions surrounding periprocedural anticoagulation management must balance thromboembolic and procedural bleed risk. The interruption of both warfarin and DOACs requires consideration of anticoagulant pharmacokinetics, procedural bleed risk and patient characteristics. There is a diminishing role for periprocedural bridging LMWH overall and no role for bridging LMWH for the procedural interruption of DOACs. A clinical approach to perioperative DOAC management based on operative bleeding risk and renal function is safe and effective, and at present, is preferred over preprocedural DOAC levels testing. Clear communication of the anticoagulation interruption plan to both the patient and the patient's care team is essential.

Keywords: Anticoagulants; Apixaban; Atrial fibrillation; Dabigatran; Perioperative period; Postoperative complications; Rivaroxaban; Warfarin.

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Conflict of interest statement

Disclosure J.R. Shaw and E. Kaplovitch have no conflicts of interest to disclose. J. Douketis has received personal fees from Janssen, Pfizer, Bayer, Bristol Myers Squibb, Sanofi, Servier Canada, and Portola Pharmaceuticals.

MeSH terms