Advances in perioperative antithrombotic therapy for general surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Yiwen ,  HU Kongwang

Department of Gastroenterological Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, P. R. China;

Corresponding author：

HU Kongwang, Email: hukw@sina.com

Keywords：

venous thromboembolism; perioperative period; antithrombotic therapy; bridging anticoagulation

DOI：

10.7507/1007-9424.201711029

Video：

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Objective To summarize the general situation of perioperative venous thromboembolism (VTE) and summarize the perioperative antithrombotic strategies. Methods Domestic and international literatures and guidelines on antithrombotic therapy were collect and reviewed. Results VTE was common during the perioperative period. Reasonable assessment of each patient’s condition during the perioperative period, as well as reasonable use of anticoagulant, antiplatelet drugs, and hemostatic agents could reduce the incidence of VTE events during the perioperative period. Conclusions Clinicians need to properly assess the timing of the usage and discontinuation of antithrombotic drugs, weigh the risk of thrombosis and bleeding, develop a rational and scientific antithrombotic strategy based on the specific circumstances of each patient. Simultaneously, hemostatic agents need to be prescribed perioperatively to reduce the incidence of thromboembolic complications.

Citation： WANG Yiwen, HU Kongwang. Advances in perioperative antithrombotic therapy for general surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(6): 754-760. doi: 10.7507/1007-9424.201711029 Copy

1.	Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 381S-453S.
2.	Bahl V, Hu HM, Henke PK, et al. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg, 2010, 251(2): 344-350.
3.	Hill J, Treasure T. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients having surgery: summary of NICE guidance. BMJ, 2007, 334(7602): 1053-1054.
4.	Liew NC, Alemany GV, Angchaisuksiri P, et al. Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism. Int Angiol, 2017, 36(1): 1-20.
5.	Hill J, Treasure T, National Clinical Guideline Centre for Acute and Chronic Conditions. Reducing the risk of venous thromboembolism in patients admitted to hospital: summary of NICE guidance. BMJ, 2010, 340: c95.
6.	Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e278S-e325S.
7.	Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis, 2016, 41(1): 3-14.
8.	Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol, 2015, 12(8): 464-474.
9.	Nakamura M, Kamei M, Bito S, et al. Spinal anesthesia increases the risk of venous thromboembolism in total arthroplasty: Secondary analysis of a J-PSVT cohort study on anesthesia. Medicine (Baltimore), 2017, 96(18): e6748.
10.	Pannucci CJ, Barta RJ, Portschy PR, et al. Assessment of postoperative venous thromboembolism risk in plastic surgery patients using the 2005 and 2010 Caprini Risk score. Plast Reconstr Surg, 2012, 130(2): 343-353.
11.	朱铁楠. 围手术期出血风险评估及处理. 中国实用内科杂志, 2017, 37(2): 108-112.
12.	刘凤林, 张太平. 中国普通外科围手术期血栓预防与管理指南. 中国实用外科杂志, 2016, 36(5): 469-474.
13.	Kubo T, Yamashita K, Onodera K, et al. Heparin bridge therapy and post-polypectomy bleeding. World J Gastroenterol, 2016, 22(45): 10009-10014.
14.	Garwood CL, Korkis B, Grande D, et al. Anticoagulation Bridge Therapy in Patients with Atrial Fibrillation: Recent Updates Providing a Rebalance of Risk and Benefit. Pharmacotherapy, 2017, 37(6): 712-724.
15.	Schwartz ML, Breecker SW. Bridging Anticoagulation. J Am Coll Cardiol, 2016, 67(7): 890-891.
16.	Rechenmacher SJ, Fang JC. Bridging Anticoagulation: Primum Non Nocere. J Am Coll Cardiol, 2015, 66(12): 1392-1403.
17.	Brotman DJ, Streiff MB. Overuse of Bridging Anticoagulation for Patients With Venous Thromboembolism: First, Do No Harm. JAMA Intern Med, 2015, 175(7): 1169-1170.
18.	Koscielny J, von Heymann C, Bauersachs R, et al. Perioperative anticoagulation with NOAC using the example of rivaroxaban. MMW Fortschr Med, 2017, 159(Suppl 4): 18-23.
19.	Bastida C, Corominas N, Sotoca JM, et al. Anticoagulation in atrial fibrillation: NOAC prescribing in primary health care. Int J Clin Pharm, 2017, 39(2): 478-482.
20.	Xing Y, Ma Q, Ma X, et al. CHADS2 score has a better predictive value than CHA2DS2-VASc score in elderly patients with atrial fibrillation. Clin Interv Aging, 2016, 11: 941-946.
21.	Steinberg BA, Piccini JP. Anticoagulation in atrial fibrillation. BMJ, 2014, 348: g2116.
22.	Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. N Engl J Med, 2015, 373(9): 823-833.
23.	Lim WY, Lloyd G, Bhattacharyya S. Mechanical and surgical bioprosthetic valve thrombosis. Heart, 2017, 103(24): 1934-1941.
24.	Özlek B, Özlek E, Başaran NF, et al. Bridging anticoagulation in patients with mechanical heart valves. Int J Cardiol, 2017, 236: 398.
25.	Moruf A, Spyropoulos AC, Schardt TQ, et al. Peri-procedural bridging with low molecular weight heparin in patients receiving warfarin for venous thromboembolism: a pediatric experience. Thromb Res, 2012, 130(4): 612-615.
26.	蔡英, 刘学波. 抗凝治疗的围术期桥接管理. 心血管病学进展, 2014, 35(3):2 98-304.
27.	Adcock DM, Gosselin R. Direct Oral Anticoagulants (DOACs) in the Laboratory: 2015 Review. Thromb Res, 2015, 136(1): 7-12.
28.	Yurttas T, Wanner PM, Filipovic M. Perioperative management of antithrombotic therapies. Curr Opin Anaesthesiol, 2017, 30(4): 466-473.
29.	Scaglione F. New oral anticoagulants: comparative pharmacology with vitamin K antagonists. Clin Pharmacokinet, 2013, 52(2): 69-82.
30.	Yogaratnam D, Ditch K, Medeiros K, et al. Idarucizumab for Reversal of Dabigatran-Associated Anticoagulation. Ann Pharmacother, 2016, 50(10): 847-854.
31.	Kaatz S, Bhansali H, Gibbs J, et al. Reversing factor Xa inhibitors - clinical utility of andexanet alfa. J Blood Med, 2017, 8: 141-149.
32.	Mallouk N, Labruyère C, Reny JL, et al. Prevalence of poor biological response to clopidogrel: a systematic review. Thromb Haemost, 2012, 107(3): 494-506.
33.	Harder S, Klinkhardt U, Alvarez JM. Avoidance of bleeding during surgery in patients receiving anticoagulant and/or antiplatelet therapy: pharmacokinetic and pharmacodynamic considerations. Clin Pharmacokinet, 2004, 43(14): 963-981.
34.	Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J, 2014, 35(35): 2383-2431.
35.	Di Minno MN, Milone M, Mastronardi P, et al. Perioperative handling of antiplatelet drugs. A critical appraisal. Curr Drug Targets, 2013, 14(8): 880-888.
36.	Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e419S-e496S.
37.	Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-segment Elevation. Rev Esp Cardiol (Engl Ed), 2015, 68(12): 1125.
38.	Ansell J, Hirsh J, Dalen J, et al. Managing oral anticoagulant therapy. Chest, 2001, 119(1 Suppl): 22S-38S.
39.	Kakos A, Allen V, Whiteside J. Factors Associated With Hemostatic Agent Use During Laparoscopic Hysterectomy. J Minim Invasive Gynecol, 2016, 23(7): 1167-1171.
40.	Farge D, Bounameaux H, Bauersachs RM, et al. Women, thrombosis, and cancer: A gender-specific analysis. Thromb Res, 2017, 151 Suppl 1: S21-S29.
41.	Burbury K. Haemostatic challenges in the cancer patient: focus on the perioperative period. Best Pract Res Clin Anaesthesiol, 2013, 27(4): 493-511.
42.	Lawson JW, Kitchens CS. Surgery and hemostasis. Curr Opin Hematol, 2015, 22(5): 420-427.

1. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 2008, 133(6 Suppl): 381S-453S.
2. Bahl V, Hu HM, Henke PK, et al. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg, 2010, 251(2): 344-350.
3. Hill J, Treasure T. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients having surgery: summary of NICE guidance. BMJ, 2007, 334(7602): 1053-1054.
4. Liew NC, Alemany GV, Angchaisuksiri P, et al. Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism. Int Angiol, 2017, 36(1): 1-20.
5. Hill J, Treasure T, National Clinical Guideline Centre for Acute and Chronic Conditions. Reducing the risk of venous thromboembolism in patients admitted to hospital: summary of NICE guidance. BMJ, 2010, 340: c95.
6. Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e278S-e325S.
7. Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis, 2016, 41(1): 3-14.
8. Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol, 2015, 12(8): 464-474.
9. Nakamura M, Kamei M, Bito S, et al. Spinal anesthesia increases the risk of venous thromboembolism in total arthroplasty: Secondary analysis of a J-PSVT cohort study on anesthesia. Medicine (Baltimore), 2017, 96(18): e6748.
10. Pannucci CJ, Barta RJ, Portschy PR, et al. Assessment of postoperative venous thromboembolism risk in plastic surgery patients using the 2005 and 2010 Caprini Risk score. Plast Reconstr Surg, 2012, 130(2): 343-353.
11. 朱铁楠. 围手术期出血风险评估及处理. 中国实用内科杂志, 2017, 37(2): 108-112.
12. 刘凤林, 张太平. 中国普通外科围手术期血栓预防与管理指南. 中国实用外科杂志, 2016, 36(5): 469-474.
13. Kubo T, Yamashita K, Onodera K, et al. Heparin bridge therapy and post-polypectomy bleeding. World J Gastroenterol, 2016, 22(45): 10009-10014.
14. Garwood CL, Korkis B, Grande D, et al. Anticoagulation Bridge Therapy in Patients with Atrial Fibrillation: Recent Updates Providing a Rebalance of Risk and Benefit. Pharmacotherapy, 2017, 37(6): 712-724.
15. Schwartz ML, Breecker SW. Bridging Anticoagulation. J Am Coll Cardiol, 2016, 67(7): 890-891.
16. Rechenmacher SJ, Fang JC. Bridging Anticoagulation: Primum Non Nocere. J Am Coll Cardiol, 2015, 66(12): 1392-1403.
17. Brotman DJ, Streiff MB. Overuse of Bridging Anticoagulation for Patients With Venous Thromboembolism: First, Do No Harm. JAMA Intern Med, 2015, 175(7): 1169-1170.
18. Koscielny J, von Heymann C, Bauersachs R, et al. Perioperative anticoagulation with NOAC using the example of rivaroxaban. MMW Fortschr Med, 2017, 159(Suppl 4): 18-23.
19. Bastida C, Corominas N, Sotoca JM, et al. Anticoagulation in atrial fibrillation: NOAC prescribing in primary health care. Int J Clin Pharm, 2017, 39(2): 478-482.
20. Xing Y, Ma Q, Ma X, et al. CHADS2 score has a better predictive value than CHA2DS2-VASc score in elderly patients with atrial fibrillation. Clin Interv Aging, 2016, 11: 941-946.
21. Steinberg BA, Piccini JP. Anticoagulation in atrial fibrillation. BMJ, 2014, 348: g2116.
22. Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. N Engl J Med, 2015, 373(9): 823-833.
23. Lim WY, Lloyd G, Bhattacharyya S. Mechanical and surgical bioprosthetic valve thrombosis. Heart, 2017, 103(24): 1934-1941.
24. Özlek B, Özlek E, Başaran NF, et al. Bridging anticoagulation in patients with mechanical heart valves. Int J Cardiol, 2017, 236: 398.
25. Moruf A, Spyropoulos AC, Schardt TQ, et al. Peri-procedural bridging with low molecular weight heparin in patients receiving warfarin for venous thromboembolism: a pediatric experience. Thromb Res, 2012, 130(4): 612-615.
26. 蔡英, 刘学波. 抗凝治疗的围术期桥接管理. 心血管病学进展, 2014, 35(3):2 98-304.
27. Adcock DM, Gosselin R. Direct Oral Anticoagulants (DOACs) in the Laboratory: 2015 Review. Thromb Res, 2015, 136(1): 7-12.
28. Yurttas T, Wanner PM, Filipovic M. Perioperative management of antithrombotic therapies. Curr Opin Anaesthesiol, 2017, 30(4): 466-473.
29. Scaglione F. New oral anticoagulants: comparative pharmacology with vitamin K antagonists. Clin Pharmacokinet, 2013, 52(2): 69-82.
30. Yogaratnam D, Ditch K, Medeiros K, et al. Idarucizumab for Reversal of Dabigatran-Associated Anticoagulation. Ann Pharmacother, 2016, 50(10): 847-854.
31. Kaatz S, Bhansali H, Gibbs J, et al. Reversing factor Xa inhibitors - clinical utility of andexanet alfa. J Blood Med, 2017, 8: 141-149.
32. Mallouk N, Labruyère C, Reny JL, et al. Prevalence of poor biological response to clopidogrel: a systematic review. Thromb Haemost, 2012, 107(3): 494-506.
33. Harder S, Klinkhardt U, Alvarez JM. Avoidance of bleeding during surgery in patients receiving anticoagulant and/or antiplatelet therapy: pharmacokinetic and pharmacodynamic considerations. Clin Pharmacokinet, 2004, 43(14): 963-981.
34. Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J, 2014, 35(35): 2383-2431.
35. Di Minno MN, Milone M, Mastronardi P, et al. Perioperative handling of antiplatelet drugs. A critical appraisal. Curr Drug Targets, 2013, 14(8): 880-888.
36. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e419S-e496S.
37. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-segment Elevation. Rev Esp Cardiol (Engl Ed), 2015, 68(12): 1125.
38. Ansell J, Hirsh J, Dalen J, et al. Managing oral anticoagulant therapy. Chest, 2001, 119(1 Suppl): 22S-38S.
39. Kakos A, Allen V, Whiteside J. Factors Associated With Hemostatic Agent Use During Laparoscopic Hysterectomy. J Minim Invasive Gynecol, 2016, 23(7): 1167-1171.
40. Farge D, Bounameaux H, Bauersachs RM, et al. Women, thrombosis, and cancer: A gender-specific analysis. Thromb Res, 2017, 151 Suppl 1: S21-S29.
41. Burbury K. Haemostatic challenges in the cancer patient: focus on the perioperative period. Best Pract Res Clin Anaesthesiol, 2013, 27(4): 493-511.
42. Lawson JW, Kitchens CS. Surgery and hemostasis. Curr Opin Hematol, 2015, 22(5): 420-427.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Advances in perioperative antithrombotic therapy for general surgery

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