Chronic Anticoagulation

Abstract

Chronic anticoagulation poses a challenge in the perioperative setting as the goals are to both minimize surgical site bleeding and avoid thromboembolic complications. While patients taking warfarin may need bridging with a shorter acting anticoagulant prior to surgery, bridging is almost never needed with the newer direct oral anticoagulants. When to stop an anticoagulant prior to surgery and when to restart an anticoagulant after surgery is dependent on several factors including the type of surgery, the medical condition requiring anticoagulation, and the type of anticoagulant.