Perioperative management of systemic oral anticoagulants in patients having outpatient hand surgery.

Long-term oral anticoagulant therapy is frequently initiated in patients with elevated risk of venous or arterial thromboembolism. The most common indications for anticoagulation are chronic atrial fibrillation, mechanical heart valves, a history of venous thromboembolism, and hypercoagulable states. In the perioperative setting, these patients pose considerable challenges to physicians, who must weigh the thrombotic risks of therapy interruption against the bleeding risks of continuation. Development of uniform recommendations for management of anticoagulated patients undergoing elective hand surgery has proven problematic. Difficulties intrinsic to study design include a short duration of risk exposure, lack of patient uniformity, and rarity of baseline adverse events. Given the paucity of substantive evidence on which to base management decisions, physicians have long relied on clinical judgment to guide their choices. This review summarizes the available data specific to elective hand surgery and provide a general context in which evidence-based treatment decisions can be made.