Complex VKA Perioperative Bridging vs. Xarelto® Simplicity
Anticoagulation and invasive procedures
One of the classical dilemmas in patients on anticoagulation is how to manage anticoagulant therapy if the patient requires an invasive procedure or elective surgery. Concerns in these situations revolve around the potential difficulty in achieving haemostasis, the concern of excessive bleeding at the time of the surgery or post-operatively, and the risk of thromboembolism. Regardless of the indication for the anticoagulation, patients taking anticoagulant medicines require careful perioperative observation and planning to avoid such complications.
Perioperative management of warfarin
The perioperative steps that are taken in the case of patients on vitamin K antagonist (VKA) treatment can be complex, demanding and time consuming. The latest guidelines by the American College of Chest Physicians (ACCP 2012 guidelines) summarise recommendations on perioperative management with VKA’s, based on the patient’s risk for thromboembolism, as follows1 (Figure 1):
- VKA should be stopped 5 days prior to surgery*
- VKA may be resumed 12 to 24 hours after surgery, when adequate haemostasis has been achieved