Gestion périopératoire des AVK

Perioperative management of long term oral anticoagulant therapy depends on the emergency stage of surgery, the patient's predisposition to thrombosis and the hemorrhagic risk of surgery. Three therapeutic options are available for scheduled surgery : continue the treatment or transient stopping with or without taking over with heparin in curative dose. Fast normalization of the International Normalized Ratio (INR) by injection of prothrombinic complex concentrates is required in urgent surgery at high risk for hemorrhage, combined with the administration of vitamin K to extend efficacy. Long term oral anticoagulant therapy is resumed postoperatively as soon as possible, combined or not with heparin depending of the predisposition to thrombosis.