Perioperative Management of Cardiac Surgical Patients Receiving Antithrombotic Agents

The two primary classes of anti-thrombotic drugs are antiplatelet and anticoagulant agents. Seeking an optimal balance between reducing the risk of thrombosis and minimizing the risk of periprocedural bleeding for cardiac surgical patients is imperative. Widespread introduction of new anticoagulant agents have made achieving this balance more challenging. This chapter will examine preoperative management of both antiplatelet and anticoagulant agents, including the decision to continue or hold therapy leading up to surgery; estimating thromboembolic risk; bridging for elective cardiac surgery patients; and estimating bleeding risk. It also examines the management of perioperative bleeding due to antithrombotic therapy.