Management of anticoagulation and platelet inhibition in reconstructive vascular surgery.

The successful management of patients with arterial or venous vascular disease is increasingly dependent on the effective use of pharmacotherapeutic agents. Anticoagulation therapies for thromboembolic disease are continually improving, and platelet inhibition remains a cornerstone treatment for all patients with atherosclerotic disease. Early ischemic complications can be avoided by proper preoperative prescription, intraoperative management, and postoperative pharmacotherapy. Combination strategies for platelet inhibition and platelet inhibition with anticoagulation are beneficial in properly selected patients; however, combining platelet inhibitors with each other and with anticoagulation generally increases bleeding risk. Unfractionated or low-molecular-weight heparin, warfarin, and long-term platelet inhibition can improve survival, reduce the risk of other vascular bed ischemic events, and improve the long-term success of the target revascularization procedure. An overview of evidence-based antithrombotic strategies will include a discussion of patients who undergo the two most common open vascular reconstructive procedures, carotid endarterectomy and infrainguinal bypass. The appropriate use of antithrombotic therapy for vascular reconstructive surgery patients has important implications for both short- and long-term patient outcomes.