Perioperative management of antithrombotic therapies

Current Opinion in Anaesthesiology
Timur YurttasMiodrag Filipovic

Abstract

Perioperative coagulation management is becoming increasingly frequent in the daily routine of the anesthesiologist and with the plethora of new substances on the market also increasingly complex. The perioperative setting poses unique challenges requiring an individualized evaluation and management of antithrombotic therapy. This review shall summarize the newest developments in this domain. New data in patients with atrial fibrillation have led to a paradigm change in the perioperative management of antithrombotics. The role of bridging therapy has been downgraded in the guidelines, which only foresee bridging in patients with high thromboembolic risk. Furthermore, direct oral anticoagulants are now a cornerstone in antithrombotic therapy, calling for specific perioperative management. The new reversal agents idarucizumab, and potentially in the future andexanet alfa and ciraparantag, will play an increasingly important role in the treatment of major bleeding in this group of patients. With the new evidence and treatment options available, perioperative coagulation management is experiencing a Renaissance, opening many interesting new doors, but also presenting the clinician with new challenges.

Associated Clinical Trials

References

Aug 25, 2001·The New England Journal of Medicine·S YusufUNKNOWN Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators
Oct 25, 2002·The New England Journal of Medicine·Dennis T Mangano, UNKNOWN Multicenter Study of Perioperative Ischemia Research Group
Aug 24, 2006·JAMA : the Journal of the American Medical Association·Clive KearonUNKNOWN Fixed-Dose Heparin (FIDO) Investigators
Nov 6, 2007·The New England Journal of Medicine·Stephen D WiviottUNKNOWN TRITON-TIMI 38 Investigators
Aug 19, 2008·Lancet·Arnoud W J Van't HofUNKNOWN Ongoing Tirofiban In Myocardial infarction Evaluation (On-TIME) 2 study group
Feb 14, 2009·The American Journal of Cardiology·Matthew J Price
Oct 21, 2009·The American Journal of Cardiology·Jan-Peter van KuijkDon Poldermans
Nov 17, 2009·The New England Journal of Medicine·Robert A HarringtonDeepak L Bhatt
Nov 17, 2009·The New England Journal of Medicine·Deepak L BhattUNKNOWN CHAMPION PLATFORM Investigators
Feb 23, 2010·JACC. Cardiovascular Interventions·Ali O Abualsaud, Mark J Eisenberg
May 6, 2010·Circulation. Cardiovascular Interventions·Nicholas L M CrudenUNKNOWN Scottish Coronary Revascularisation Register Steering Committee
Jan 19, 2012·JAMA : the Journal of the American Medical Association·Dominick J AngiolilloUNKNOWN BRIDGE Investigators
Jan 26, 2012·Thrombosis and Haemostasis·Nora MalloukSilvy Laporte
Mar 21, 2012·Journal of Thrombosis and Haemostasis : JTH·T ThieleA Greinacher
Jun 16, 2012·Expert Review of Clinical Pharmacology·Kallirroi I KalantziAlexandros D Tselepis
Jun 27, 2012·Archives of Internal Medicine·Marc R Dweck, Nicholas L Cruden
Aug 31, 2012·Blood·Alex C Spyropoulos, James D Douketis
Jan 8, 2013·Clinical Pharmacokinetics·Francesco Scaglione
Jul 23, 2013·Journal of Thrombosis and Thrombolysis·Leslie SkeithMichael J Kovacs
Apr 1, 2014·The New England Journal of Medicine·P J DevereauxUNKNOWN POISE-2 Investigators
Sep 13, 2014·Journal of the American College of Cardiology·Adam CukerDavid A Garcia
Mar 17, 2015·The New England Journal of Medicine·Marc P BonacaUNKNOWN PEGASUS-TIMI 54 Steering Committee and Investigators
May 15, 2015·Circulation·Sam SchulmanUNKNOWN Periop Dabigatran Study Group
May 20, 2015·Thrombosis Research·D M Adcock, R Gosselin
May 29, 2015·Thrombosis and Haemostasis·Charles V PollackJeffrey I Weitz
Jun 17, 2015·International Journal of Toxicology·Dexter W SullivanSolomon Steiner
Jun 23, 2015·The New England Journal of Medicine·James D DouketisUNKNOWN BRIDGE Investigators
Sep 2, 2015·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Hein HeidbuchelPaulus Kirchhof
Sep 19, 2015·Journal of the American College of Cardiology·Stephen J Rechenmacher, James C Fang

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Citations

May 26, 2021·Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology·An-Sofie VandeputConstantinus Politis

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