Importance of Perioperative Anti-thrombotic Management

Perioperative anti-thrombotic management is crucial for patients undergoing surgeries, especially those at high risk of bleeding or thromboembolic events. It involves assessing the bleeding and thromboembolic risks of the procedure and the patient's individual characteristics. Aspirin therapy is generally continued for secondary prevention but may be held for primary prevention in high bleeding risk surgeries. P2Y12 inhibitors such as clopidogrel may be stopped five days before surgery and restarted after 48 hours. The timing of the first dose of warfarin postoperatively is usually 24 hours after surgery, while low molecular weight heparin or IV heparin may be used for bridging. The duration of holding antiplatelet therapy depends on the type of patient and procedure, with consideration given to drug-eluting stents and bare metal stents. Collaboration with cardiologists and other specialists is essential for decision-making and patient care.