Contemporary approaches to perioperative anticoagulant management in surgical patients: a literature review

Perioperative anticoagulation management requires balancing thromboembolic prevention with bleeding risk. With the growing use of oral anticoagulants, this review synthesizes current evidence and guideline recommendations to support safe decision-making. A systematic search of scientific databases up to 28 May 2025 identified studies on perioperative anticoagulation. Review articles, animal studies, and non-English publications were excluded. Methodological quality was assessed using The Scale for the Assessment of Narrative Review Articles (SANRA). Oral anticoagulants fall into two main groups: vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). DOACs, with predictable kinetics and short half-lives, allow brief interruption and rarely require bridging. VKAs, by contrast, have variable pharmacodynamics, often necessitating prolonged discontinuation and bridging with low-molecular-weight or unfractionated heparin. DOACs have simplified management, but high-risk procedures and vulnerable populations still require tailored planning, reversal protocols, and occasional bridging. High-bleeding-risk procedures typically necessitate temporary interruption, whereas many low-risk procedures can proceed without cessation. In emergencies, both targeted and non-specific reversal agents provide therapeutic options. Risk stratification tools such as CHA₂DS₂-VASc and HAS-BLED further guide individualized decisions. Optimal perioperative anticoagulation requires integration of patient-specific thromboembolic risk, procedural bleeding risk, and drug properties. Multidisciplinary collaboration and adherence to evidence-based guidelines remain essential for safe outcomes.