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Vol. 217. Issue 2.
Pages 103-107 (March 2017)
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Vol. 217. Issue 2.
Pages 103-107 (March 2017)
Review
Use of oral anticoagulation for patients who undergo invasive procedures
Uso de la anticoagulación oral en el paciente sometido a un procedimiento invasivo
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D. Sánchez Fuentesa,
Corresponding author
dfuentes@saludcastillayleon.es

Corresponding author.
, M.A. Budiño Sáncheza, M.P. López Sánchezb
a Servicio de Medicina Interna, Complejo Asistencial de Ávila , Ávila, Spain
b Medicina Familiar y Comunitaria, ABS Santa Coloma de Farnés, Gerona, Spain
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Tables (4)
Table 1. Classification of procedures according to their hemorrhagic risk.
Table 2. Gradation of thromboembolic risk for various processes.1
Table 3. Suggested schedule for the indication of bridge therapy for the temporary discontinuation of vitamin K antagonists.
Table 4. Discontinuation and restart time for direct-acting oral anticoagulants before and after an invasive procedure.
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Abstract

The performance of invasive procedures in patients undergoing oral anticoagulation represents a risk. Without conclusive data on this issue, the recommendations on managing oral anticoagulation are generally weak, and its management is controversial and heterogeneous.

We conducted a review of the evidence on the elective periprocedural management of oral anticoagulation following the publication of the 9th edition of the guidelines of the American College of Chest Physicians.

Except for cases of procedures with minimal hemorrhagic risk, the use of oral anticoagulants is suspended with sufficient time so that it can be performed without a significant anticoagulant effect, which will depend on the half-life of the drug. For direct oral anticoagulants, the half-life is determined by the renal function.

Recent studies have shown that the use of bridge therapy with heparin in patients who temporarily suspended the use of oral anticoagulation provided no benefits and increased the bleeding. However, there is no conclusive evidence against its use in patients with a high thromboembolic risk.

Keywords:
Oral anticoagulation
Temporary suspension
Invasive procedure
Resumen

La realización de procedimientos invasivos en pacientes con anticoagulación oral es un riesgo. Sin unos datos concluyentes al respecto, las recomendaciones sobre el manejo, por lo general, son de escasa solidez, y su manejo es controvertido y heterogéneo.

Se realiza una revisión de las evidencias sobre el manejo periprocedimiento electivo de la anticoagulación oral después de la publicación de la 9.ª edición de la guía del American College of Chest Physicians.

Salvo en caso de procedimientos con riesgo hemorrágico mínimo, los anticoagulantes orales serán suspendidos justo con la antelación necesaria para que se realice sin efecto anticoagulante significativo, lo que dependerá de la vida media del fármaco, que en el caso de los anticoagulantes orales de acción directa está condicionada por la función renal.

Estudios recientes muestran que la utilización de terapia puente con heparina en pacientes que interrumpen temporalmente la anticoagulación oral no aporta beneficios e incrementa los sangrados; sin embargo, no hay evidencia concluyente contra su uso en pacientes con alto riesgo tromboembólico.

Palabras clave:
Anticoagulación oral
Suspensión temporal
Procedimiento invasivo

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