Anesthetic concerns for patients with coagulopathy.

Journal Article (Journal Article;Review)

PURPOSE OF REVIEW: Patients often receive preoperative therapies that interfere with hemostasis, and can present for surgery with underlying hemostatic disorders because of pre-existing preoperative anticoagulation or antiplatelet therapy. Perioperative bleeding can occur following surgery due to multiple causes; however, the addition of pharmacologic agents creates an acquired defect that complicates the surgical injury and may result in increased blood loss. An understanding of the potential impact of anticoagulation therapies on hemostasis is critical in managing these patients. Further, newer agents are evolving in clinical practice that clinicians should be aware of. RECENT FINDINGS: The anticoagulants and antiplatelet agents that patients are receiving preoperatively apart from unfractionated heparin include low-molecular-weight heparins (LMWHs); a pentasaccharide (fondaparinux); oral anticoagulants: vitamin K antagonists (warfarin), new oral Xa inhibitors (rivaroxaban, apixiban), or the oral direct thrombin inhibitor (DTI) dabigatran; platelet inhibitors: thienopyridines (clopidogrel, ticlopidine, prasugrel) or IIb/IIIa receptor antagonists (tirofiban, abciximab, eptifibatide); or DTIs (r-hirudin, bivalirudin, argatroban). SUMMARY: There are multiple pharmacologic therapies that surgical patients may be exposed to preoperatively, although there are currently few available methods to antagonize their effects. Often therapeutic prohemostatic pharmacologic approaches are used to treat or prevent bleeding, in addition to transfusional therapies.

Full Text

Duke Authors

Cited Authors

  • Levy, JH; Azran, M

Published Date

  • June 2010

Published In

Volume / Issue

  • 23 / 3

Start / End Page

  • 400 - 405

PubMed ID

  • 20375882

Electronic International Standard Serial Number (EISSN)

  • 1473-6500

Digital Object Identifier (DOI)

  • 10.1097/ACO.0b013e328339480a


  • eng

Conference Location

  • United States