Perioperative management of patients receiving long-term antithrombotic therapy. Clinical practice recommendations of the national “Federation of Anesthesiologists and Reanimatologists”
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Keywords

anticoagulant therapy
antiplatelet therapy
interruption of antithrombotic therapy
emergency reversion
regional anesthesia
thromboembolic risk
hemorrhagic risk
artificial heart valves
atrial fibrillation
ischemic stroke
myocardial infarction
coronary stent

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Zabolotskikh IB, Kirov MY, Afonchikov VS, Bulanov AY, Grigoryev EV, Grigoryev SV, Gritsan AI, Zamyatin MN, Kurapeev IS, Lebedinskii KM, Lomivorotov VV, Lubnin AY, Ovechkin AM, Potievskaya VI, Roitman EV, Sinkov SV, Subbotin VV, Shadrin RV, Shulutko EM Perioperative management of patients receiving long-term antithrombotic therapy. Clinical practice recommendations of the national “Federation of Anesthesiologists and Reanimatologists”. Annals of Critical Care. 2021;(3):7–26. doi:10.21320/1818-474X-2021-3-7-26.

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Abstract

The review presents the methodological recommendations of the Federation of Anesthesiologists and Resuscitators for the management of patients receiving long-term antithrombotic therapy, revised in 2021. The classification of complications and the degree of hemorrhagic risk, stratification of perioperative thromboembolic risk are presented. Taking into account modern concepts, the principles of interruption and resumption of antithrombotic, anticoagulant and antiplatelet therapy are described. Approaches to the emergency interruption of antithrombotic therapy during urgent surgical interventions, including emergency reversion of the effects of drugs received by the patient, are presented. The features of the appointment and changes in the tactics of antithrombotic therapy depending on the thromboembolic and hemorrhagic risk in such concomitant diseases and conditions as the presence of artificial heart valves, atrial fibrillation, ischemic stroke, myocardial infarction, coronary stenting are described. A separate section is devoted to thrombohemorrhagic safety when performing regional anesthesia against the background of antithrombotic therapy. Indications, contraindications and limitations for regional anesthesia in the context of antithrombotic therapy are given. Criteria for the quality of the provided medical care are given.
https://doi.org/10.21320/1818-474X-2021-3-7-26
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