Hysterectomy pp 299-305 | Cite as

Perioperative Management of Antithrombotic Therapy in the Periprocedural Period of Patients Undergoing Hysterectomy

  • Verena LimpergerEmail author
  • Florian Langer
  • Rolf Mesters
  • Ralf Ulrich Trappe
  • Ulrike Nowak-Göttl


Oral anticoagulants (Vitamin-K-Antagonists, Dabigatran, Rivaroxaban, Apixaban, Edoxaban) or antiplatelet agents (Acetylsalicylic acid, Clopidogrel, Prasugrel, Ticagrelor) are effective in preventing thromboembolic diseases. In case of interventional of surgical procedures patients with indications for chronic anticoagulation (atrial fibrillation, valve prosthesis, venous thromboembolism) or use of antiplatelet agents (cerebrovascular events, cardiovascular events) will require interruption of antithrombotic/antiplatelet therapy with the need of replacement with a short-acting agent. Due to limited data available from randomized studies and meta-analyses the evidence level is low in the majority of recommendations. Therefore for each patient the bleeding and thrombosis risk depending on the individual patient constitution and the planned intervention must be weighted. In patients with an intermediate risk for thrombosis the bleeding risk of the scheduled intervention will influence the bridging recommendation: In patients with a low bleeding risk oral anticoagulation/ antiplatelet therapy can be continued or reduced in intensity. In patients with an intermediate or high bleeding risk along with a low thrombosis risk a temporary interruption of the anticoagulation/antiplatelet therapy is feasible. In patients with a high thrombosis and bleeding risk anticoagulation should be bridged with unfractionated heparin (renal insufficiency) or low molecular weight heparin. In the latter risk situation, inhibition of platelet function can be achieved with short-lasting GPIIb-IIIa inhibitors (Eptifibatide, Tirofiban). Prior to intervention patients treated with the new oral anticoagulants (Dabigatran; Rivaroxaban; Apixaban; Edoxaban) are requested to temporary interrupt the anticoagulation depending on the individual drug half-life and their renal function. Bridging therapy with heparin prior to intervention is not necessary with the new/ direct oral anticoagulants.


Bridging Oral anticoagulants Platelet function inhibition New oral anticoagulants Direct oral anticoagulants 


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Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • Verena Limperger
    • 1
    Email author
  • Florian Langer
    • 2
  • Rolf Mesters
    • 3
  • Ralf Ulrich Trappe
    • 4
  • Ulrike Nowak-Göttl
    • 5
  1. 1.Institute of Clinical Chemistry, University Hospital Schleswig HolsteinKielGermany
  2. 2.II. Medizinische Klinik und PoliklinikUniversitätskliniken EppendorfHamburgGermany
  3. 3.Medizinische Klinik und Poliklinik AUniversity Hospital MünsterMünsterGermany
  4. 4.Hematology and OncologyEv. Diakonie-Krankenhaus gemeinnützige GmbHBremenGermany
  5. 5.University Hospital Schleswig-Holstein, Institute of Clinical Chemistry, Thrombosis and Haemostatsis Treatment UnitKielGermany

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