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Anticoagulation in the Older Surgical Patient

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Cardiothoracic Surgery in the Elderly

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Abstract

This chapter covers the delicate balance of the use of anticoagulation in older surgical patients, including those undergoing cardiothoracic (CT) surgery, and those with existing prosthetic valves who undergo other surgeries. Increasing age, alone, augments the risk of thromboembolic events in addition to comorbidities commonly seen in older patients (prior stroke, diabetes, atrial fibrillation and cancer). Older patients are also more prone to bleeding due to inadvertent over-anticoagulation, comorbidites (GI bleeding), and other medications affecting bleeding. Managing the older surgical patient on chronic oral anticoagulation therapy (OAT), when to stop therapy, when to use bridging therapy with heparin, when and how to reverse OAT, and how to resume OAT is covered. This section includes recommendations for patients with prosthetic heart valves. Strategies for venothromoembolism (VTE) prophylaxis in the perioperative period of specific surgeries is presented with multiple agents. Lastly, post-surgical conditions requiring anticoagulation such as VTE, atrial fibrillation, myocardial infarction, and valve implantation are presented. Age-specific reductions in warfarin loading and maintenance doses as well as strategies to reduce major bleeding events and intracranial hemorrhage are covered.

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Authors and Affiliations

  1. National Institute on Aging, National Institutes of Health, 7201 Wisconsin Ave, Suite 3C307, Bethesda, MD, 20892, USA

    Susan J. Zieman

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  1. M. Kate Elfrey
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  2. Susan J. Zieman
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Correspondence to Susan J. Zieman .

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Editors and Affiliations

  1. , Department of Thoracic Surgery, Geisinger Wyoming Valley Medical Center, 1000 East Mountain Drive, Wilkes-Barre, 18711, Pennsylvania, USA

    Mark R. Katlic

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Elfrey, M.K., Zieman, S.J. (2011). Anticoagulation in the Older Surgical Patient. In: Katlic, M. (eds) Cardiothoracic Surgery in the Elderly. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0892-6_17

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  • DOI: https://doi.org/10.1007/978-1-4419-0892-6_17

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