Anticoagulation in Cardiovascular Diseases

Abstract

With the increasing prevalence of cardiovascular disease amongst the aging population as well as the expanding indications for the use of oral anticoagulants, physicians are more likely to encounter patients on these medications in the inpatient and outpatient settings. To provide appropriate care for these patients, physicians must understand the pharmacology of the available oral anticoagulants, the clinical indication for anticoagulation, and the appropriate preoperative, perioperative, and postoperative management of these patients. While short-term anticoagulation is often times achieved with the use of intravenous or subcutaneous heparin, chronic anticoagulation is achieved with warfarin or other newer novel anticoagulants (NOAC). Due to the different pharmacologic properties, each of the anticoagulants provides varying challenges and limitations in the clinical setting. Patient with cardiovascular disease have numerous indications for requiring chronic anticoagulant therapy including atrial fibrillation/flutter, prosthetic heart valves, significant heart failure including those requiring mechanical assist devices, and thromboembolic disease. Understanding the clinical indication necessitating the use of oral anticoagulation as well as the specific pharmacology of these agents is essential to providing adequate care to these patients. This chapter provides an in-depth review of the numerous anticoagulant strategies available, the indications for prescribing these therapies, as well as the preoperative, perioperative, and postoperative management of patients on these medications.