Operationen und Interventionen bei Indikation zur Antikoagulation

Abstract

The management of oral anticoagulant and antiplatelet therapy before and after interventions is often difficult. Decision-making should take into account the individual patients’ risk factors for bleedings and ischemic events. The so-called bridging therapy with short acting anticoagulants is recommended in patients under OAC at high risk for thromboembolic (TE) events and might be withheld in patients at low TE risk. The interruption of dual antiplatelet therapy must be avoided in patients at high risk for stent-thrombosis and might be safely performed in subjects with stable coronary artery disease > 12 months. Until now we found no evidence favoring a bridging algorithm for dual antiplatelet therapy analogue to an oral anticoagulant treatment.

Kernaussagen

• Das optimale periinterventionelle Vorgehen bei Patienten unter einer antithrombotischen Therapie sollten alle Beteiligten (Kardiologe, Operateur, Anästhesist) unter den Aspekten des chronischen und akuten Blutungs- und Ischämierisikos gemeinsam planen.

• Wichtige Informationen sind die Art und Dringlichkeit der Intervention, die Blutungswahrscheinlichkeit und ‑lokalisation, die Beherrschbarkeit stattfindender Blutungen und mögliche Alternativeingriffe.

• Die Notwendigkeit und das Ausmaß einer gerinnungshemmenden Therapie muss man hinsichtlich des individuellen Ischämierisikos einschätzen. Über die Notwendigkeit dieses Vorgehens müssen der Patient und sein behandelnder Arzt informiert sein.

• Der Stellenwert neuer Antikoagulanzien und Plättchenhemmer in einem perioperativen Umfeld ist noch unklar.

• Literatur

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