Scientific Online Resource System

Annual for Hospital Pharmacy

Management Of Oral Anticoagulation In Patients, Undergoing Elective Surgery Or Invasive Procedures

Antoniya Kisheva, Aylin Hadjiveli


Oral anticoagulants play a key role in prevention and treatment of cardiovascular diseases. In the last years, the number of patients taking oral anticoagulants is growing and we have more medicaments in use. The aim of this review is to study the management of anticoagulated patients, undergoing elective surgery or invasive procedures. The scientific information for this review is taken from PubMed. The decision about the oral anticoagulation depends of the bleeding risk, associated with the procedure, of the individual thromboembolic and bleeding risk. After the evaluation, the proper strategy is chosen, which could be temporary interruption, bridging with parenteral anticoagulant or continuing therapy. We have algorithms, but individual approach and multidisciplinary care is needed.


anticoagulants, thromboembolic risk, bleeding risk, surgery, invasive procedures

Full Text


Кирилов Б, Стоименова А, Григоров Е, Георгиев Ст, Петкова-Георгиева Е. Рационална употреба на лекарства. ТЕА Дизайн. 2019. ISBN 978-619-90647-9-5

Belov I, Vinokurov IA. Anticoagulants in surgical practice. Khirurgiia (Mosk), 2013; 45-48

Georgiev KD, Hvarchanova N, Georgieva M, Kanazirev B. The role of the clinical pharmacist in the prevention of potential drug interactions in geriatric heart failure patients. Int J Clin Pharm, 2019;41(6):1555–1561.

Majeed A, Hwang H, Connolly S, Eikelboom J, Ezekowitz M et al. Management and outcomes of major bleeding during treatment with dabigatran or warfarin. Circulation, 2013; 128:2325-2332. DOI: 10.1161/CIRCULATIONAHA.113.002332

Mashour GA, Shanks AM, Kheterpal S. Perioperative stroke and associated mortality after noncardiac, nonneurologic surgery. Anesthesiology, 2011;114:1289–1296.

Llau JV, Ferrandis R, Castillo J et al. Management of direct action oral anticoagulants in the perioperative period and invasive techniques. Rev Esp Anestesiol Reanim, 2012;59:321-330.

Capodanno D, Angiolillo D. Management of antiplatelet therapy in patients with coronary artery disease requiring cardiac and noncardiac surgery. Circulation., 2013; 128:2785-2798.

Spyropoulos A, Al-Badri A, Sherwood M, Douketis J. Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery. J Thromb Haemost, 2016;14:875-885.

Raval A, Cigarroa J, Chung M et al. Management of patients on non-vitamin K antagonist oral anticoagulants in the acute care and periprocedural setting: a scientific statement from the American Heart Association. Circulation, 2017;135:e604-e633

Doherty J, Gluckman T, Hucker W et al. 2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: a report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol, 2017;69:871-898.

Гетов И, Костов Е, Лебанова Х, Григоров Е. Клинична фармация – същност, развитие и предизвикателства за практиката. Медицински преглед, 2013;49(3):30-36.

Веков Т. Фармацевтичната грижа – неусвоена възможност за подобряване на общественото здраве. Обща медицина, 2014; 16(1):35-38

Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation, 2011;123(23):2736-47.

Steffel J, Verhamme P, Potpara T, Albaladejo P, Antz M 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):1330-1393.

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 ESCEndorsed by the European Stroke Organisation (ESO). European Heart Journal, 2016;37:2893-2962.

Fox K, Virdone S, Pieper K, GARFIELD-AF Investigators. P5708 Balancing risk and benefit in patients with atrial fibrillation: the GARFIELD-AF risk score, European Heart Journal, 2019;40(Supplement_1)

Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012;141(2 Suppl):e326S-e350S.

Nixon JV. Left ventricular mural thrombus. Arch Intern Med, 1983;143(8):1567-71.

Tran HA, Chunilal SD, Harper PL, Tran H, Wood EM, Gallus AS. An update on concensus guidelines for warfarin reversal. The Medical Journal of Australia, 2013;198(4):198-199.

Birnie D, Healey J, Wells G, BRUISE CONTROL Investigators. Pacemaker or defibrillator surgery without interruption of anticoagulation. N Engl J Med, 368 (2013):2084-2093.

Birnie D. A randomized controlled trial of continued versus interrupted direct oral anti-coagulant at the time of device surgery - BRUISE CONTROL-2. En: American Heart Association Annual Scientific Sessions (AHA 2017); 2017 Nov 11-15; Anaheim, California, Estados Unidos. Available at:

Gotoh S, Yasaka M, Nakamura A, Kuwashiro T, Okada Y. Management of Antithrombotic Agents During Surgery or Other Kinds of Medical Procedures With Bleeding: The MARK Study. JAHA, 2020;9(5).

Alegria-Barrero E, Alegria-Barrero A. How to manage anticoagulated patients undergoing elective surgery or invasive pr, April 2019,

Vivac D, Roldán I, Ferrandis R, Marín F, Roldán V et al. Perioperative and Periprocedural Management of Antithrombotic Therapy: Consensus Document of SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT and AEU. Revista Española de Cardiología (English Edition), 2018;71(7):553–564.

Балкански Ст, Пейкова Л, Григоров Е, Гетов И. Преглед на употребата на ниски дози ацетилсалицилова киселина като антитромботична терапия. Сърдечно-съдови заболявания, 2014;45(3):3-9.



Article Tools
Email this article (Login required)