How to Manage the Perioperative Patient on Combined Anticoagulant and Antiplatelet Therapy: Comments on the 2020 ACC Consensus Decision Pathway

Abstract

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Emergency surgical decompression for spontaneous spinal epidural hematoma in octogenarians: risk factors, clinical outcomes, and complications

“…One potential explanation may be that the geriatric population and especially octogenarians, due to their pure baseline history with multiple prolonged comorbidities, may require discontinuation intervals since their renal function is substantially impaired (creatinine clearance of less than 30 mL/min) [ 24 ]. Previous studies have stated that impaired renal function is a significant risk factor and prolongs the effects of anticoagulant agents despite discontinuation before surgery or the use of antidotes to counter their effect [ 4 , 5 ]. Noteworthily, according to the findings of the present study, over 40% of the examined patients presented with a chronic renal failure, while all the 10 patients who received anticoagulant agents suffered from impaired renal function.…”

Coagulation and Aging: Implications for the Anesthesiologist

“…Regular laboratory monitoring to evaluate safe drug levels and adequate efficacy might be indicated in the elderly to allow safe administration of DOACs [28]. Further, repeated assessments of the risks vs. benefits of anticoagulation and the correction and minimization of adjustable factors for increased bleeding in elderly patients while on anticoagulant therapy is strongly recommended [25,30,39].…”

Perioperative Guidelines on Antiplatelet and Anticoagulant Agents: 2022 Update

“…Antithrombotic drugs are frequently used to prevent or treat various common cardiovascular disorders like acute coronary syndrome (ACS), stroke, peripheral vascular disease, atrial fibrillation (AF), and venous thromboembolism (VTE). Two main classes of oral antithrombotic drugs are on the market: antiplatelet drugs, which prevent or temper inadvertent or inadequate platelet activation and initial clot formation, and anticoagulants, which slow down clot formation by controlling and reducing thrombin generation and formation of stable clots [1]. Aspirin and P2Y 12 inhibitors are the most commonly used antiplatelet drugs, either alone or as dual antiplatelet therapy (DAPT) [2•].…”

“…Thus, it is estimated that in patients with AF, which is the dominant clinical indication for long-term anticoagulant therapy, 10 to 15% will require treatment interruption annually for an elective surgery or invasive procedure [6]. Finally, due to multiple shared risk factors for VTE and arteriosclerotic diseases, combined antiplatelet and anticoagulant therapy is indicated in some patients [1,7]. The combined therapy might be associated with specially increased bleeding risk during surgical intervention.…”