Thromboseprophylaxe und perioperative Therapie mit Antikoagulantien

Perioperative thromboprophylactic therapy is performed with low-molecular-weight heparin (LMWH) in most cases in Germany. When administering LMWH to patients, attention needs to be paid to individual renal function. In patients with impaired renal function, the dose of the anticoagulant must be adapted where necessary. LMWH are also the standard of care in the so-called bridging therapy. The term bridging is used as a description for the cessation of the use of an oral vitamin K antagonist and the use of an alternative anticoagulant. Recent data showed that the extent of the anticoagulation during the bridging period might have been too distinct. In patients with low to medium risk for developing arterial or venous thrombembolism, the high-risk thromboprophylaxis dosage of enoxaparin or nadroparin seems to be sufficient for adequate prevention of thrombembolism. A special focus must be on previous acute coronary syndromes or coronary stent implantation when stopping single or dual anti-platelet therapy. Non-critical stopping without adherence to current position papers and guidelines may have lethal consequences for the patient.