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Vol. 71. Issue 10.
Pages 879 (October 2018)
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Vol. 71. Issue 10.
Pages 879 (October 2018)
Letter to the Editor
DOI: 10.1016/j.rec.2018.05.032
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Antithrombotic Therapy and Surgery: From Consensus to Clinical Practice. Response to Related Letters
Antitrombóticos y cirugía: del consenso a la práctica clínica. Respuesta a cartas relacionadas
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David Vivasa,b,
Corresponding author
dvivas@secardiologia.es

Corresponding author:
, Jose Luis Ferreiroc, Inmaculada Roldánd
a Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
b Unidad de Cardiología, Clínica MD Anderson, Madrid, Spain
c Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge - IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
d Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
Related content
Rev Esp Cardiol. 2018;71:87810.1016/j.rec.2018.05.024
Enrique Martín-Rioboó, Cristina Martín-Mañero, Paula Medina-Durán, Luis Angel Pérula-de Torres
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To the Editor,

First of all, we would like to thank Santiago de Dios and Martín-Rioboó et al. for their interest in the consensus document on the perioperative and periprocedural management of antithrombotic therapy.1 We would like to clarify the following regarding the comments received:

The situation of patients on anticoagulants and antiplatelet agents is complex and in our opinion the decision to stop one of these drugs (and when to do so) must be individualized in each patient. Regarding patients with low ischemic risk (essentially after 1 year) who are taking anticoagulation alone, there is no evidence to generate a recommendation in this consensus for the use of antiplatelet agents as a “bridge” therapy in the perioperative period.2

The consensus document recommends limiting bridge therapy and reserving it only, according to the available evidence, for patients with of high thromboembolic risk.3 The recommended dose of low-molecular weight heparin refers to a full anticoagulation dose, which is restarted after the procedure depending on the bleeding risk and is later stopped once the adequate international normalized ratio is reached with oral anticoagulation.4 In patients receiving prophylactic doses of parenteral anticoagulation prior to intervention, it is recommended that the last dose be taken 12hours previously; if the parenteral anticoagulation is used at a therapeutic dose, the recommendation is to stop it 24hours previously.

As to the classification of operations and procedures according to bleeding risk, these have been stratified by all the participating societies according to their criteria and evidence.1 Given that there may be some disagreement for certain procedures, and to facilitate the application of the recommendations, the consensus document leaves open the possibility of not stopping anticoagulation in such cases, as is explained in the text and in the footer of Table 1 in the supplementary material.

In conclusion, we hope that the consensus document will be a useful, practical, easy-to-use tool and that it will help implement local multidisciplinary protocols to avoid the adverse consequences of variability in clinical practice.

.

References
[1]
D. Vivas, I. Roldán, R. Ferrandis, et al.
Perioperative and Periprocedural Management of Antithrombotic Therapy: Consensus Document of SEC, SEDAR, SEACV, SECTCV, AEC, SECPRE, SEPD, SEGO, SEHH, SETH, SEMERGEN, SEMFYC, SEMG, SEMICYUC, SEMI, SEMES, SEPAR, SENEC, SEO, SEPA, SERVEI, SECOT and AEU.
Rev Esp Cardiol., 71 (2018), pp. 553-564
[2]
B.A. Steinberg, S. Kim, J.P. Piccini, et al.
Use and associated risks of concomitant aspirin therapy with oral anticoagulation in patients with atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Registry.
Circulation., 128 (2013), pp. 721-728
[3]
B.A. Steinberg, E.D. Peterson, S. Kim, et al.
Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).
Circulation., 131 (2015), pp. 488-494
[4]
A.C. Spyropoulos, A. Al-Badri, M.W. Sherwood, J.D. Douketis.
Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery.
J Thromb Haemost., 14 (2016), pp. 875-885
Copyright © 2018. Sociedad Española de Cardiología
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