PMID- 21852212
OWN - NLM
STAT- MEDLINE
DCOM- 20120126
LR  - 20131031
IS  - 1877-0568 (Electronic)
IS  - 1877-0568 (Linking)
VI  - 97
IP  - 6 Suppl
DP  - 2011 Oct
TI  - Focus on perioperative management of anticoagulants and antiplatelet agents in 
      spine surgery.
PG  - S102-6
LID - 10.1016/j.otsr.2011.07.005 [doi]
AB  - Perioperative management of anticoagulants and antiplatelet agents is based on a 
      compromise between the risk of hemorrhage induced by maintaining (or substituting 
      for) them and the risk of thrombosis if they are discontinued. The hemorrhage 
      risk in major spinal surgery is clear (50-81% incidence of transfusion), and the 
      incidence of postoperative symptomatic spinal hematoma varies between 0.4% and 
      0.2% depending on whether low-molecular-weight heparin (LMWH) is prescribed 
      postoperatively. The French Health Authority, in 2008, published guidelines on 
      the management of patients treated with vitamin K antagonists. Treatment may be 
      stopped without preoperative replacement in certain cases of atrial fibrillation 
      or venous thromboembolic disease; otherwise, preoperative replacement by curative 
      dose unfractionated heparin (UFH) or LMWH is recommended, with withdrawal early 
      enough to avoid peroperative bleeding. Postoperative care should take account of 
      hemorrhagic risk following surgery. The management of patients treated with 
      antiplatelets is delicate, as maintenance is preferable in most of the situations 
      in which they are prescribed (bare or active stenting, or secondary prevention of 
      myocardial infarction, stroke or peripheral ischemia), although they are liable 
      to increase the risk of perioperative hemorrhage, especially when associated to 
      antithrombotic prophylaxis. If surgery cannot be performed under treatment 
      continuation, the interruption should be as short as possible. New guidelines are 
      presently being drawn up under the auspices of the French Health Authority. In 
      both types of treatment, the strategy should be jointly determined by surgeon, 
      anesthesiologist and cardiologist, to optimize individualized care taking account 
      of each party's requirements, with the patient in the central role. The selected 
      strategy should be clearly stated in the patient's file. LEVEL OF EVIDENCE: V.
CI  - Copyright (c) 2011 Elsevier Masson SAS. All rights reserved.
FAU - Steib, A
AU  - Steib A
AD  - Anesthesiology and Surgical Intensive Care Department, Nouvel Hopital Civil, 1, 
      place de l'Hopital, 67091 Strasbourg cedex, France. 
      annick.steib@chru-strasbourg.fr
FAU - Hadjiat, F
AU  - Hadjiat F
FAU - Skibba, W
AU  - Skibba W
FAU - Steib, J-P
AU  - Steib JP
CN  - French Spine Surgery Society
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110817
PL  - France
TA  - Orthop Traumatol Surg Res
JT  - Orthopaedics & traumatology, surgery & research : OTSR
JID - 101494830
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 12001-79-5 (Vitamin K)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Blood Loss, Surgical
MH  - Hemorrhage/epidemiology/*prevention & control
MH  - Humans
MH  - *Orthopedic Procedures
MH  - Perioperative Care
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Postoperative Care
MH  - Practice Guidelines as Topic
MH  - Risk Assessment
MH  - Spine/*surgery
MH  - Venous Thrombosis/epidemiology/*prevention & control
MH  - Vitamin K/antagonists & inhibitors
EDAT- 2011/10/14 06:00
MHDA- 2012/01/27 06:00
CRDT- 2011/09/28 06:00
PHST- 2011/03/22 00:00 [received]
PHST- 2011/04/05 00:00 [accepted]
PHST- 2011/09/28 06:00 [entrez]
PHST- 2011/10/14 06:00 [pubmed]
PHST- 2012/01/27 06:00 [medline]
AID - S1877-0568(11)00146-0 [pii]
AID - 10.1016/j.otsr.2011.07.005 [doi]
PST - ppublish
SO  - Orthop Traumatol Surg Res. 2011 Oct;97(6 Suppl):S102-6. doi: 
      10.1016/j.otsr.2011.07.005. Epub 2011 Aug 17.