Our Summary

This research paper presents guidance on how to monitor and manage patients who are taking blood thinning drugs (direct oral anticoagulants) and are about to undergo heart surgery. The advice comes from members of the European Association of Cardiothoracic Anaesthesiology. They recommend that most patients can be safely managed if the blood thinning medication is stopped two days before surgery. In patients with kidney or liver issues, or a high risk of bleeding, the blood levels of the anticoagulant drugs need to be tested and found to be below a certain level. If it’s not possible to test the blood levels, then the medication should be stopped for four days before surgery. They also suggest a specific test for a certain type of these drugs (FXa inhibitors) to ensure there is a sufficient reduction in the blood thinning effect. Lastly, they advise that it’s not necessary to use a short-term alternative blood thinner (heparin) before surgery.

FAQs

  1. What is the recommended time to stop taking blood thinning drugs before heart surgery according to the European Association of Cardiothoracic Anaesthesiology?
  2. How should patients with kidney or liver issues, or a high risk of bleeding, be managed before heart surgery?
  3. Is it necessary to use a short-term alternative blood thinner before surgery?

Doctor’s Tip

Overall, the key takeaway for patients undergoing cardiac surgery while taking blood thinning medication is to work closely with your healthcare team to ensure a safe and successful surgery. It is important to follow their guidance on when to stop the medication before surgery and to undergo any necessary blood tests to monitor the levels of the medication in your system. By following these recommendations, you can help reduce the risk of bleeding complications during and after your surgery.

Suitable For

Patients who are typically recommended cardiac surgery include those with:

  1. Coronary artery disease: This is a condition where the blood vessels that supply the heart muscle with oxygen-rich blood become narrowed or blocked, leading to chest pain (angina) or a heart attack.

  2. Heart valve disease: This can involve damage or defects in one or more of the heart’s valves, which can affect the flow of blood through the heart and cause symptoms such as chest pain, shortness of breath, or fatigue.

  3. Heart failure: This is a condition where the heart is unable to pump enough blood to meet the body’s needs, leading to symptoms such as shortness of breath, fatigue, and swelling in the legs and abdomen.

  4. Aortic aneurysm: This is a bulge in the wall of the aorta, the body’s largest artery, which can be life-threatening if it ruptures.

  5. Arrhythmias: These are abnormal heart rhythms that can cause symptoms such as palpitations, dizziness, or fainting.

Overall, patients who are at high risk of complications from their heart condition, or who have symptoms that are not well controlled with medication or other treatments, may be recommended for cardiac surgery to improve their heart function and quality of life.

Timeline

Before cardiac surgery:

  • Patient is prescribed blood thinning medication (direct oral anticoagulants)
  • Patient is informed by their healthcare provider about the need to stop taking the medication before surgery
  • Blood levels of the anticoagulant drugs may be tested to ensure they are below a certain level
  • In some cases, specific tests may be required for certain types of anticoagulants to ensure a sufficient reduction in blood thinning effect
  • Patient may need to stop taking the medication for two to four days before surgery

After cardiac surgery:

  • Patient undergoes the surgical procedure
  • Patient is monitored closely for any signs of bleeding or clotting complications
  • Patient may be given alternative blood thinners or other medications to prevent blood clots or manage bleeding
  • Healthcare provider provides instructions for resuming blood thinning medication post-surgery, if needed
  • Patient is advised on follow-up care and monitoring to ensure proper healing and recovery from surgery

What to Ask Your Doctor

  1. How long before the surgery should I stop taking my blood thinning medication?
  2. Will I need any specific tests to monitor the levels of the blood thinning medication in my system?
  3. Are there any additional risks associated with stopping my blood thinning medication before surgery?
  4. What is the plan for managing my blood thinning medication during and after the surgery?
  5. Are there any alternative medications or treatments that can be used in place of my blood thinning medication during the surgery?
  6. How will my recovery be affected by stopping my blood thinning medication?
  7. Are there any specific precautions I should take before and after the surgery related to my blood thinning medication?
  8. What is the risk of excessive bleeding during or after the surgery due to my blood thinning medication?
  9. How will my other medical conditions, such as kidney or liver issues, impact the management of my blood thinning medication during surgery?
  10. Are there any specific signs or symptoms I should watch for after the surgery related to my blood thinning medication?

Reference

Authors: Erdoes G, Martinez Lopez De Arroyabe B, Bolliger D, Ahmed AB, Koster A, Agarwal S, Boer C, von Heymann C. Journal: Anaesthesia. 2018 Dec;73(12):1535-1545. doi: 10.1111/anae.14425. Epub 2018 Sep 27. PMID: 30259961