Background: Patients treated with antithrombotic therapy that require abdominal surgical procedures
have progressively increased over time. The management of antithrombotics during both the peri- and postoperative
period is of crucial importance.
Methods: The goal of this review is to present current data concerning the management of antiplatelets in patients
with coronary artery disease and of anticoagulants in patients with atrial fibrillation who had to undergo abdominal
surgical operations. For this purpose, the incidence of major adverse cardiovascular events (MACE) and risk
of antithrombotic use during surgical procedures, as well as the recommendations based on recent guidelines were
reported. A thorough search of PubMed, Scopus and the Cochrane Databases was conducted to identify randomized
controlled trials, observational studies, novel current reviews, as well as ESC and ACC/AHA guidelines on
Results: Antithrombotic use in daily clinical practice leads to two different pathways: reduction of thromboembolic
risk, but a simultaneous increase of bleeding risk. This may cause a therapeutic dilemma during the perioperative
period. Nevertheless, careless cessation of antithrombotics can increase MACE and thromboembolic
events. However, maintenance of antithrombotic therapy may increase bleeding complications. Studies and current
guidelines can help clinicians in making decisions for the treatment of patients that undergo abdominal surgical
operations while on antithrombotic therapy. Aspirin should not be stopped perioperatively in the majority of
surgical operations. Determining whether to discontinue the use of anticoagulants before surgery depends on the
surgical procedure. In surgical operations with a low risk for bleeding, oral anticoagulants should not be discontinued.
Bridging therapy should only be considered in patients with a high risk of thromboembolism. Finally, in
patients with an intermediate risk for thromboembolism, management should be individualized according to patient’s
thrombotic and bleeding risk.
Conclusion: Management of antithrombotics therapy during the perioperative period in patients undergoing abdominal
surgery should follow a patient-centered approach according to a patient’s medical history and thrombotic
risk weighted for bleeding risk.