Perioperative Management of Patients Receiving Oral Anticoagulation Therapy

摘要

There is no consensus on whether patients taking oral anticoagulation medications who need to undergo surgery should receive perioperative intravenous heparin or subcutaneous low-molecular-weight heparin (aggressive strategies) or simply have oral anticoagulation withheld and restarted after the procedure (minimalist strategy). This review examines the literature examining perioperative management of oral anticoagulation. Due to the limited quality of prior studies, it is not possible to draw conclusions on the relative efficacy and safety of aggressive and minimalist strategies. The literature suggests that major bleeding on therapeutic oral anticoagulation is rare for certain procedures (e.g., dental). For other procedures, the literature does not provide a reliable estimate of the increase in postoperative bleeding due to therapeutic-dose anticoagulation. Mathematical modeling indicates that for most patients the risk of perioperative stroke is low and that an aggressive strategy is unnecessary and possibly harmful. Further studies are needed to determine which patients at intermediate and high risk of stroke benefit from aggressive management.