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Perioperative management of antithrombotic therapies

Yurttas, Timur*; Wanner, Patrick M.*; Filipovic, Miodrag

Current Opinion in Anaesthesiology: August 2017 - Volume 30 - Issue 4 - p 466–473
doi: 10.1097/ACO.0000000000000481
DRUGS IN ANESTHESIA: Edited by Jürgen Schüttler

Purpose of review 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.

Recent findings 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.

Summary 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.

Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, Switzerland

Correspondence to Miodrag Filipovic, Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, CH-9007 St. Gallen, Switzerland. E-mail:

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