Knowledge of antithrombotic treatment in patients undergoing invasive procedures in general medical practice

James Douketis

In the setting of general medical practice, what is the necessary extent of knowledge on antithrombotic treatment in patients undergoing invasive procedures?

James Douketis: The general physician should have a working knowledge of the pharmacokinetic properties of these antithrombotic drugs. Basically, you need to know that with low-molecular-weight heparins it is 3 to 4 hour-half-life; for the novel anticoagulants (NOACs), it is about 10 to 12 hour-half-life; for warfarin, we know that 5 days are needed to remove the effect; and for the antiplatelet drugs like aspirin or clopidogrel, it is 7 to 10 days.

I think that is important because you do not want to be stopping these drugs too close to surgery or too far away for surgery – you want to find that sweet spot that minimizes patients’ risk for both bleeding and cardiovascular or thromboembolic events.

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