Update on Perioperative Antithrombotic Management

In this review, we discuss the recent studies and recommendations on the perioperative management of oral anticoagulant and antiplatelet drugs.

In elective surgery, clear and simple recommendations exist for oral anticoagulants and antiplatelet drugs. The shorter stopping intervals with direct-acting oral anticoagulants have simplified the perioperative management compared with vitamin K antagonists. The specific use of laboratory testing is suggested for bleeding patients treated with antithrombotic drugs or for emergent surgery. The postoperative prevention of thromboembolism has gained more attention, and individualized strategies including extended treatment or use of aspirin has been suggested in specific patients. The use of risk scores might be helpful for decision making.

The perioperative management of anticoagulants and antiplatelet drugs is still challenging, especially in urgent or emergent surgery. The use of individualized strategies to prevent perioperative bleeding and thromboembolic events rather than a “one-size-fits-all” approach is suggested.