Perioperative Management of Anticoagulants

Background: The prevalence of anticoagulant use has increased in the United States. Medical providers have the responsibility to explain to patients the management of anticoagulant regimens before an invasive procedure. The pharmacologic characteristics of these medications, specifically their half-lives, are important in timing an interruption of anticoagulant therapy. Objective: The authors review the current guidelines and recommendations for therapeutic interruption of anticoagulants and the involved pharmacologic factors. Methods: Guidelines and other literature are summarized with discussion on the pharmacology of each medication. Recommendations on how and when to provide bridging for anticoagulants are discussed. Newer oral anticoagulants also are discussed, along with interruption recommendations. Results: Literature reveals a conservative approach for using bridging when anticoagulation is interrupted because of higher risks of bleeding. Caution is advised when resuming anticoagulant therapy when neuraxial anesthesia is used. Conclusion: Perioperative healthcare providers need to balance risks and benefits of anticoagulant therapy with its interruption preoperatively.