ISSN (print) 1726-9806     ISSN (online) 1818-474X
No. 2 (2025), CLINICAL GUIDELINES
No. 2 (2025)
CLINICAL GUIDELINES

Perioperative management of patients receiving anticoagulants and antiplatelet agents. Clinical practice recommendations of the All­Russian public organization “Federation of Anesthesiologists and Reanimatologists” and the non­profit corporate organization “National Association of Specialists in Thrombosis, Clinical Hemostasis and Hemorheology”. Revision 2025

Published 30.04.2025
Igor B. Zabolotskikh
Kuban State Medical University, Krasnodar, Russia; Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia; Krasnodar Regional Clinical Hospital No 2, Krasnodar, Russia
https://orcid.org/0000-0002-3623-2546
M.Yu. Kirov
Northern State Medical University, Arkhangelsk, Russia
https://orcid.org/0000-0002-4375-3374
S.V. Sinkov
Kuban State Medical University, Krasnodar, Russia; Krasnodar Regional Clinical Hospital No 2, Krasnodar, Russia
https://orcid.org/0000-0003-4483-4077
V.S. Afonchikov
Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia
https://orcid.org/0000-0003-4851-0619
A.Yu. Bulanov
N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
https://orcid.org/0000-0001-6999-8145
E.V. Grigoryev
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
https://orcid.org/0000-0001-8370-3083
S.V. Grigoryev
Kuban State Medical University, Krasnodar, Russia; Krasnodar Regional Clinical Hospital No 2, Krasnodar, Russia
https://orcid.org/0000-0002-9753-7351
A.I. Gritsan
Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
https://orcid.org/0000-0002-0500-2887
M.N. Zamyatin
Pirogov National Medical and Surgical Center, Moscow, Russia
https://orcid.org/0000-0002-2072-7798
I.S. Kurapeev
North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
https://orcid.org/0000-0002-2341-4658
K.M. Lebedinskii
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia; North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
https://orcid.org/0000-0002-5752-4812
V.V. Lomivorotov
Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
https://orcid.org/0000-0001-8591-6461
A.Yu. Lubnin
ФГАУ «Национальный научно-практический центр нейрохирургии им. академика Н.Н. Бурденко» Минздрава России, Москва, Россия
https://orcid.org/0000-0003-2595-5877
A.M. Ovechkin
Sechenov First Moscow State Medical University, Moscow, Russia
https://orcid.org/0000-0002-3453-8699
V.I. Potievskaya
National Medical Research Radiological Centre, Moscow, Russia
https://orcid.org/0000-0002-2459-7273
E.V. Roitman
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0002-3015-9317
V.V. Subbotin
ГБУЗ «Московский клинический научный центр им. А.С. Логинова» Департамента здравоохранения города Москвы, Москва, Россия
https://orcid.org/0000-0002-0921-7199
E.M. Shulutko
Russian Medical Academy of Continuous Professional Education, Moscow, Russia
https://orcid.org/0000-0001-7312-6796
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HTML_2025-2_11-46-S (Russian)

Keywords

anticoagulants
platelet aggregation inhibitors
interruption of antithrombotic therapy
emergency reversion
regional anesthesia
thromboembolism
bleeding
artificial heart valves
atrial fibrillation
ischemic stroke
myocardial infarction
coronary stent

How to Cite

Zabolotskikh I.B., Kirov M.Y., Sinkov S.V., Afonchikov V.S., Bulanov A.Y., Grigoryev E.V., Grigoryev S.V., Gritsan A.I., Zamyatin M.N., Kurapeev I.S., Lebedinskii K.M., Lomivorotov V.V., Lubnin A.Y., Ovechkin A.M., Potievskaya V.I., Roitman E.V., Subbotin V.V., Shulutko E.M. Perioperative management of patients receiving anticoagulants and antiplatelet agents. Clinical practice recommendations of the All­Russian public organization “Federation of Anesthesiologists and Reanimatologists” and the non­profit corporate organization “National Association of Specialists in Thrombosis, Clinical Hemostasis and Hemorheology”. Revision 2025. Annals of Critical Care. 2025;(2):11–46. doi:10.21320/1818-474X-2025-2-11-46.
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Abstract

Perioperative management of patients receiving anticoagulants and antiplatelet agents is a complex task that requires a balance between the risk of thromboembolic complications and the risk of bleeding. Due to the increasing number of patients taking antithrombotic drugs, the relevance of developing modern recommendations for their perioperative management increases. Particular attention is paid to patients with comorbidities such as atrial fibrillation, ischemic stroke, myocardial infarction and coronary stenting. The article presents the guidelines of the Federation of Anesthesiologists and Reanimatologists and the National Association of Specialists in Thrombosis, Clinical Hemostasis and Hemorheology for the management of patients receiving anticoagulants and antiplatelet agents, revised in 2025. The guidelines for the perioperative management of patients receiving anticoagulants and antiplatelet agents have been updated, taking into account modern concepts of the risks of thromboembolism and bleeding. Particular attention focused to risk stratification, interruption and resumption of antithrombotic therapy, and the safety of regional anesthesia during anticoagulant therapy.

The recommendations use data from modern studies, meta-analyses, and clinical trials on the perioperative management of patients receiving anticoagulants and antiplatelet agents. Various methods of thromboprophylaxis are considered, including the use of low molecular weight heparins, fondaparinux, and other anticoagulants. Particular attention is paid to risk stratification using the Caprini, HAS-BLED, and CHA2DS2-VASc scales.

Recommendations are proposed for interruption and resumption of antithrombotic therapy depending on the risk of thromboembolism and bleeding. Criteria for the quality of compliance with recommendations, as well as algorithms for patient management during elective and emergency surgeries, are developed. The guidelines provide clinicians with practical tools to manage perioperative risk in patients receiving anticoagulants and antiplatelet agents. An important aspect is the individual approach to each patient, taking into account their clinical situation and risks.

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