Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 603

In general, anticoagulant therapy should be stopped before the vast majority of surgical and other invasive procedures, but not stopping anticoagulant therapy is acceptable for low‐risk procedures with a risk of very minor or clinically insignificant bleeding.⁶³

Based on the available evidence, the use of heparin bridging would only be for patients with a high thromboembolic risk. In patients being treated with a VKA, it is sufficient to start LMWH or UFH when the INR is less than 2 or, where this value is not available, when two to three doses of the drug have been omitted. Bridging therapy is not necessary with DOACs.

It is recommended to resume anticoagulant therapy 24 hours after the procedure. As the anticoagulant effect of VKAs starts to set in at 24 to 72 hours, it is useful to manage heparin bridging therapy in patients with a high thromboembolic risk, but this recommendation is not necessary with DOACs. Reintroduction of oral anticoagulant therapy should be postponed for 48 to 72 hours only in patients with a high risk of postoperative bleeding.⁶³