Anticoagulants

Care of the vascular surgical patient requires an updated, evidence-based approach to the management of anticoagulation. In addition to managing arterial and venous thrombi, vascular surgeons also must be adept at managing the frequently encountered co-morbid conditions of our patient population as well as careful perioperative and intraoperative decisions to balance the risk of bleeding and recurrent thrombosis. e homeostatic mechanisms governing this delicate and complex process are regulated by the endothelium, extracellular tissue and circulating blood proteins and cells. An in-depth review of the nuances and complex interactions of the coagulation cascade is beyond the scope of this chapter. is chapter reviews current FDA-approved anticoagulants, focusing on mechanisms of action and pharmacokinetics, indications and supporting data, important side eects, drug monitoring and reversal and perioperative management in an attempt to improve the care of the vascular patient. e recent introduction of several new anticoagulants and reversal agents makes this topic especially pertinent (Figure 8.1).