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

2016-10-20
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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