Perioperativer Umgang mit Antikoagulation

@article{Lock2017PerioperativerUM,
  title={Perioperativer Umgang mit Antikoagulation},
  author={J. F. Lock and Johanna Wagner and Verena Luber and Ulrich Andreas Dietz and Sven Lichthardt and Niels Matthes and Katica Krajinovic and Christoph T. Germer and Stefan Knop and Armin Wiegering},
  journal={Der Chirurg},
  year={2017},
  volume={89},
  pages={95-102}
}
ZusammenfassungEine zunehmende Anzahl an Menschen in Deutschland erhält eine langfristige prophylaktische Antikoagulation mit Phenprocoumon oder einem der neuen direkten oralen Antikoagulanzien (NOAK) wie Dabigatran, Rivaroxaban und Apixaban. Die mit großem Abstand häufigste Indikation zur oralen Antikoagulation ist Vorhofflimmern (ca. 75 % der Betroffenen), bei welchem das Risiko für ein embolisches Ereignis, insbesondere Apoplex, durch eine Antikoagulation um ca. 60 % verringert werden kann… 
3 Citations
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Perioperative management of anticoagulant therapy
TLDR
The perioperative handling of the oral anticoagulant therapy differs according to the periprocedural bleeding risk, and a bridging therapy is not recommended in patients with a low risk for thromboembolism.
Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery
TLDR
Perioperative bridging anticoagulation, especially full-therapeutic dose LMWH, markedly increases the risk of postoperative bleeding complications in general and visceral surgery and surgeons should carefully consider the practice of routine bridging.

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TLDR
Perioperative consideration of the bridging strategy is mandatory in patients who need antithrombotic therapy for cardiovascular diseases (anticoagulants or antiplatelet therapy) periprozedural Umstellungen der antithombotischen Therapie unter Akzeptanz eines erhöhten Blutungsrisikos erforderlich.
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TLDR
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TLDR
Vitamin K antagonist–treated patients receiving periprocedural heparin bridging appear to be at increased risk of overall and major bleeding and at similar risk of thromboembolic events compared to nonbridged patients.
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The periprocedural management of patients receiving chronic therapy with oral anticoagulants (OACs), including vitamin K antagonists (VKAs) such as warfarin and direct OACs (DOACs), is a common
The HAS-BLED score predicts bleedings during bridging of chronic oral anticoagulation. Results from the national multicentre BNK Online bRiDging REgistRy (BORDER).
TLDR
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TLDR
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TLDR
In case of major intra-operative bleeding in patients likely to have therapeutic or supra-therapeutic levels of anticoagulation, specific reversal agents/antidotes would be of value but are currently lacking, as a consequence, a multimodal approach should be taken.
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