J Thachil1, A Gatt, V Martlew. 1. Department of Haematology, University of Liverpool, Royal Free Hospital, London, UK. jeckothachil@yahoo.co.uk
Abstract
BACKGROUND: Temporary interruption of long-term anticoagulation and antiplatelet therapy during surgical procedures exposes patients to thrombotic risk. Continuation of these agents, however, is associated with an increased risk of bleeding. Managing anticoagulation can be a particular challenge in the emergency setting. METHODS: A literature review of published articles sourced using the keywords heparin, warfarin, perioperative, antiplatelet, aspirin and surgery was undertaken. A management plan for all likely situations was developed. RESULTS AND CONCLUSION: Based on an individual assessment of risk factors for arterial or venous thromboembolism and the risk of perioperative bleeding, it is possible to form an anticoagulant and antiplatelet management plan likely to achieve a low incidence of bleeding and thrombosis. A multidisciplinary approach is desirable.
BACKGROUND: Temporary interruption of long-term anticoagulation and antiplatelet therapy during surgical procedures exposes patients to thrombotic risk. Continuation of these agents, however, is associated with an increased risk of bleeding. Managing anticoagulation can be a particular challenge in the emergency setting. METHODS: A literature review of published articles sourced using the keywords heparin, warfarin, perioperative, antiplatelet, aspirin and surgery was undertaken. A management plan for all likely situations was developed. RESULTS AND CONCLUSION: Based on an individual assessment of risk factors for arterial or venous thromboembolism and the risk of perioperative bleeding, it is possible to form an anticoagulant and antiplatelet management plan likely to achieve a low incidence of bleeding and thrombosis. A multidisciplinary approach is desirable.
Authors: Rosemary A Kozar; Saman Arbabi; Deborah M Stein; Steven R Shackford; Robert D Barraco; Walter L Biffl; Karen J Brasel; Zara Cooper; Samir M Fakhry; David Livingston; Frederick Moore; Fred Luchette Journal: J Trauma Acute Care Surg Date: 2015-06 Impact factor: 3.313
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