Committee opinion no 610: chronic antithrombotic therapy and gynecologic surgery.

Surgery can present a management dilemma for gynecologists whose patients receive chronic antithrombotic therapy because the risk of hemorrhagic complications must be balanced against the risk of thromboembolic complications. Interruption of antithrombotic therapy to reduce perioperative bleeding poses a significant risk of recurrent thromboembolic events. Patients who receive chronic antithrombotic therapy should be seen at least 7 days before a planned procedure, and each woman should be included in decision making regarding risks and benefits specific to her situation. The schedule may need to be altered if the international normalized ratio is at a high level and in patients older than 75 years of age (who may need more time to correct their international normalized ratio). The patient's cardiologist often will have recommendations for the appropriate bridging therapy for a specific valve or stent. A discussion of the risks and benefits of different management schemes for chronic antithrombotic therapy may involve the surgeon, the patient, the anesthesiologist, and the primary care physician.