- There are increasing numbers of people on anticoagulants and their risk of thrombosis and risk of bleeding needs to be assessed to make a sensible decision regarding their anticoagulation in the peri-operative period .
- Patients with a high risk of thrombosis who are having a major procedure may require bridging therapy with low molecular weight heparin or unfractionated heparin. The newer oral anticoagulants have a much shorter onset and offset time than warfarin making bridging therapy either unnecessary or shorter in duration .
- For some operations with a low bleeding risk such as, dental procedures, pacemaker insertion, cataracts and some endoscopic procedures it may be possible to continue anticoagulation if the bleeding risk is acceptable [3,4,5].
- Patients that have a high surgical bleeding risk can be treated with pre-operative parental tranexamic acid in cardiac and trauma surgery without an increased thrombosis risk .