Managing the Patient on Antiplatelet, Anticoagulation, Beta Blockers, Angiotensin-Converting Enzyme Inhibitors, Angiotensin-Receptors Blockers: The Anesthesia Perspective

Surgical patients treated with anticoagulants and/or antiplatelets require a clear plan regarding the management of their hemostasis-altering medications throughout the perioperative period. These therapies are often prescribed to treat morbid conditions such as deep vein thrombosis and cardiac or cerebral embolic events, as well as prevention of embolic events in the presence of cardiac arrhythmias, prosthetic valves, or risk factors for deep vein thrombosis or pulmonary embolism. Withholding such medications is not without risk, which varies depending on the primary condition for which the medications are prescribed. On the other hand, maintaining such therapies may exacerbate the risk of perioperative bleeding. The management of medications in the perioperative period does not only concern drugs-related coagulation hemostasis. Preexisting hypertension imposes the challenge of managing antihypertensive medications. These patients are more likely to experience intraoperative blood pressure and hemodynamic fluctuations that may lead to myocardial injury. Many areas of controversy remain regarding the optimal management of perioperative medications. International guidelines offer an evidence-based framework and can help the clinician navigate through these complex clinical dilemmas.