Contemporary approaches to perioperative anticoagulant management in surgical patients: a literature review
Year: 2026
Type: review
Study design: Systematic Review
Abstract: Perioperative anticoagulation management requires balancing thromboembolic prevention with bleeding risk. With the growing use of oral anticoagulants, this review synthesizes current evidence and guideline recommendations to support safe decision-making. A systematic search of scientific databases up to 28 May 2025 identified studies on perioperative anticoagulation. Review articles, animal studies, and non-English publications were excluded. Methodological quality was assessed using The Scale for the Assessment of Narrative Review Articles (SANRA). Oral anticoagulants fall into two main groups: vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). DOACs, with predictable kinetics and short half-lives, allow brief interruption and rarely require bridging. VKAs, by contrast, have variable pharmacodynamics, often necessitating prolonged discontinuation and bridging with low-molecular-weight or unfractionated heparin. DOACs have simplified management, but high-risk procedures and vulnerable populations still require tailored planning, reversal protocols, and occasional bridging. High-bleeding-risk procedures typically necessitate temporary interruption, whereas many low-risk procedures can proceed without cessation. In emergencies, both targeted and non-specific reversal agents provide therapeutic options. Risk stratification tools such as CHA₂DS₂-VASc and HAS-BLED further guide individualized decisions. Optimal perioperative anticoagulation requires integration of patient-specific thromboembolic risk, procedural bleeding risk, and drug properties. Multidisciplinary collaboration and adherence to evidence-based guidelines remain essential for safe outcomes.
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7133135507