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New Guidelines: Managing Blood Thinners Before Surgery
Published: Sep 23, 2024
Recent medical guidelines have updated how doctors should manage blood thinners in patients undergoing surgery. These changes aim to reduce complications and simplify care. What do you need to know?
Shift Away from Bridging
One major change is moving away from routine use of 'bridging' therapy. This involves using injectable blood thinners when stopping oral medications before surgery. New evidence shows bridging increases bleeding risk without reducing clots for most patients. It's now reserved for only the highest-risk cases.
Tailored Approach for Each Patient
Guidelines now emphasize a more personalized approach. Doctors should consider each patient's specific clotting risk, bleeding risk, and type of blood thinner. For example, patients with atrial fibrillation have different needs than those with mechanical heart valves. This individualized strategy helps balance risks more effectively.
Timing of Medication Stops and Starts
New recommendations provide clearer guidance on when to stop and restart blood thinners around surgery. Newer medications like apixaban or rivaroxaban can often be stopped closer to surgery than warfarin. After surgery, most patients can restart their medication within 24-72 hours, depending on bleeding risk.
Special Considerations
The guidelines address special situations like emergency surgery or procedures with very high bleeding risk (e.g., spinal anesthesia). They provide protocols for using reversal agents when needed and managing patients with impaired kidney function. There's also guidance on handling antiplatelet medications like aspirin alongside blood thinners.
Frequently Asked Questions
Yes, but specific recommendations vary by medication type.
Possibly - discuss with your doctor if you have upcoming procedures.
They're widely accepted but some regional variations exist.
Major updates typically occur every 3-5 years as new evidence emerges.
Yes, they provide recommendations for dental work too.
Moving Forward
These updated guidelines aim to improve safety and simplify management of blood thinners before surgery.
References
- Douketis JD et al. Chest. 2022;162(5):e207-e253.
- Steffel J et al. Europace. 2021;23(10):1612-1676.
- Horlocker TT et al. Reg Anesth Pain Med. 2018;43(3):263-309.
This article has been reviewed for accuracy by one of the licensed medical doctors working for Doctronic. Always discuss health information with your healthcare provider.
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