PRACTICAL ASPECTS OF ANTITHROMBOTIC THERAPY IN PATIENTS REQUIRING LONG-TERM ORAL ANTICOAGULANTS DURING SURGICAL INTERVENTIONS
https://doi.org/10.51922/1818-426X.2026.3.51
Abstract
Some patients require long-term oral anticoagulants. The need for and duration of discontinuation of oral anticoagulants if surgical intervention is necessary depends on the balance of bleeding and thrombotic risks and the type of anticoagulant. This article classifies surgical procedures based on the risk of perioperative bleeding. For procedures with minimal bleeding risk, discontinuing oral anticoagulants is not required. For procedures with moderate to high bleeding risk, discontinuing oral anticoagulants is necessary. The withdrawal period for direct oral anticoagulants is shorter than with warfarin. The need for bridge therapy with parenteral anticoagulants depends on the risk of thrombosis and the duration of oral anticoagulant withdrawal. Groups of patients with a very high risk of thrombosis have been identified. For those with a low to moderate risk of thrombosis and a short-term interruption of oral anticoagulants, bridging therapy is not required. In cases of very high risk of thrombosis and/or prolonged period of withdrawal of oral anticoagulants, bridge therapy is recommended during the period of interruption of oral anticoagulant use.
About the Authors
I. V. Kornelyuk
Belarusian State Medical University
Belarus
Belarus
Minsk
S. E. Aleksejchik
Belarusian State Medical University
Belarus
Belarus
Minsk
M. N. Kornelyuk
Republican Scientific and Practical Center “Cardiology”
Belarus
Belarus
Minsk
References
1. Kirchhof, P., Benussi S., Kotecha D. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: the Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC: endorsed by the European Stroke Organisation (ESO) // European Heart Journal. – 2016. – № 37(38). – Р. 2893–2962. – doi: 10.1093/eurheartj/ehw210.
2. Rivera-Caravaca, J. M., Roldan V., Esteve-Pastor M. A., Valdes M., Vicente V., Lip G. Y. H. et al. Cessation of oral anticoagulation is an important risk factor for stroke and mortality in atrial fibrillation patients // Thromb Haemost. – 2017. – Vol. 117(7). – P. 1448–1454. – doi: 10.1160/TH16-12-0961.
3. Dewilde, W. J., Janssen P. W., Kelder J. C., Verheugt F. W., De Smet B. J., Adriaenssens T. et al. Uninterrupted oral anticoagulation versus bridging in patients with long-term oral anticoagulation during percutaneous coronary intervention: subgroup analysis from the WOEST trial. EuroIntervention. – 2015. – № 11(4). – Р. 381–390. – doi: 10.4244/EIJY14M06_07.
4. Gibson, C. M., Mehran R., Bode C., Halperin J., Verheugt F., Wildgoose P. et al. An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI) // American Heart Journal. – 2015. – № 169(4). – Р. 472–478.
5. Kowalewski, M., Suwalski P., Raffa G. M., Słomka A., Kowalkowska M. E., Szwed K. A. et al. Meta-analysis of uninterrupted as compared to interrupted oral anticoagulation with or without bridging in patients undergoing coronary angiography with or without percutaneous coronary intervention // Internal Journal of Cardiology. – 2016. – Vol. 223. – P. 186–194. – doi: 10.1016/j.ijcard.2016.08.089.
6. Lip, G. Y., Windecker S., Huber K., Kirchhof P., Marin F., Ten Berg J. M. et al. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS) // European Heart Journal. – 2014. – № 35(45). – Р. 3155–3179. – doi: org/10.1093/eurheartj/ehu298.
7. Keeling, D., Tait R. C., Watson H. Peri-operative management of anticoagulation and antiplatelet Therapy. British Committee for Standards in Haematology // British Journal of Haematology. – 2016. – № 175(4). – Р. 602–613. – doi: 10.1111/bjh.14344.
8. Jan Steffel, Peter Verhamme, Tatjana S. Potpara et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation // European Heart Journal. – 2018. – № 39(16). – Р. 1330–1393. – doi: 10.1093/eurheartj/ehy136.
9. Michael Moster, Daniel Bolliger Perioperative Guidelines Antiplatelet and Anticoagulant Agents: 2022 Update Current Anesthesiology Reports. – 2022. – № 12. – Р. 286–296.
10. Gregory, Y., Lip H., Jean-Phillippe Collet, Michael Haude, Robert Byrne, Eugene H. Chung et al. 2018 Joint European consensus document on the management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous cardiovascular interventions: a joint consensus document of the European Heart RhythmAssociation (EHRA), European Society of Cardiology Working Group on Thrombosis, European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), LatinAmerica Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA). Europace. – 2019. – № 21(2). – Р. 192–193. – doi: 10.1093/europace/euy174.
11. Erdoes, G., B. Martinez Lopez De Arroyabe, Bolliger D., Ahmed A. B., Koster A., Agarwal S., Boer C., von Heymann C. International consensus statement on the peri-operative management of direct oral anticoagulants in cardiac surgery // Anaesthesia. – 2018. – № 73(12). – Р. 1535–1545. – doi: 10.1111/anae.14425.
12. Steffel, Ronan Collins, Matthias Antz, Pieter Cornu, Lien Desteghe et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation // Europace. – 2021. – № 23(10). – Р. 1612–1676.
13. Douketis, James D., Spyropoulos Alex C. Perioperative Management of Patients Taking Direct Oral Anticoagulants A Review //jAMA. – 2024. – № 332(10). – Р. 825–834. – doi: 10.1001/jama.2024.12708.
14. Annemarie Thompson, Kirsten E. Fleischmann, Nathaniel R. Smilowitz, Lisa de las Fuentes, Debabrata Mukherjee, Niti R. Aggarwal et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/ SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines // Circulation. – 2024. – № 150(19). – Р. e351–e442. – doi: org/10.1161/CIR.0000000000001285.
15. Douketis, James D., Spyropoulos Alex C., Hassan Murad M., Tafur Alfonso J., Tang Liang V., Moores Lisa K. et al. Perioperative Management of Antithrombotic Therapy An American College of Chest Physicians Clinical Practice Guideline. CHEST. – 2022. – № 162(5). – Р. e207–e243.
16. Maninder, Singh, Zachary A. Sporn, Hartzell V. Schaff, Patricia A. Pellikka. ACC/AHA Versus ESC Guidelines on Prosthetic Heart Valve Management: JACC Guideline Comparison //journal Americam College of Cardiology. – № 7(13). – Р. 1707–1718. – doi: 10.1016/j.jacc.2019.01.038.
17. Van Gelder, Isabelle C., Rienstra Michiel, Bunting Karina V., Casado-Arroyo Ruben, Caso Valeria et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) // European Heart Journal. – 2024. – № 45(36). – Р. 3314–3414. – doi: 10.1093/eurheartj/ehae176.
18. Neumann, Franz-Josef, Sousa-Uva Miguel, Ahlsson Anders, Alfonso Fernando, Banning Adrian P. et al. 2018 ESC/EACTS Guidelines on myocardial Revascularization the Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) // European Heart Journal. – 2018. – № 40(2). – Р. 87–165. – doi: 10.1093/eurheartj/ehy394.
19. Byrne, Robert A., Rossello Xavier, Coughlan J. J., Barbato Emanuele, Berry Colin et al. 2023 ESC Guidelines for the management of acute coronary syndromes; Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC) // European Heart Journal. – 2023. – № 44(38). – Р. 3720–3826. – doi: org/10.1093/eurheartj/ehad191.
20. Christiaan, Vrints, Felicita Andreotti, Konstantinos C. Koskinas, Xavier Rossello, Marianna Adamo et al. 2024 ESC Guidelines for the management of chronic coronary syndromes Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) // European Heart Journal. – 2024. – № 45(36). – Р. 3415–3537. – doi: org/10.1093/eurheartj/ehae177.
21. Romanova, I. S., Kozhanova I. N., Kardash O. F. i soavt. Profilaktika venoznyh trombozov v hirurgicheskoj praktike. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Prevention of venous thrombosis in surgical practice // Emergency cardiology and cardiovascular risks]. – 2024. – № 8 (1). – Р. 2073–2085. – doi: https://doi.org/10.51922/2616-633X.2024.8.1.2073 [In russian].
Review
For citations:
Kornelyuk I.V., Aleksejchik S.E., Kornelyuk M.N. PRACTICAL ASPECTS OF ANTITHROMBOTIC THERAPY IN PATIENTS REQUIRING LONG-TERM ORAL ANTICOAGULANTS DURING SURGICAL INTERVENTIONS. Medical Journal. 2026;(3):51-56. (In Russ.) https://doi.org/10.51922/1818-426X.2026.3.51
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