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Anticoagulants are widely used in the perioperative period. The anesthesia consultant must have an understanding of their pharmacology and the implications of their use in a myriad of clinical scenarios. Intricate and complex processes that influence coagulation and anticoagulation are always in a dynamic state of equilibrium. The balance is shifted one way or the other by various disease states, medications, or perioperative events (ie, hemodilution with aggressive resuscitation). Anesthesiologists are often called upon to find a reasonable balance between anticoagulation and hemostasis in a variety of circumstances, such as during procedures associated with blood loss in patients at risk for arterial thrombotic events or when managing postoperative neuraxial analgesia in patients at high risk for deep vein thrombosis. The focus of this chapter is on elements of anticoagulant clinical pharmacology that are important for anesthesiologists to understand. Anticoagulation drugs represent a rapidly expanding field, with many novel agents in various stages of testing and approval. However, this chapter will be confined to classes of anticoagulants and antiplatelets in clinical use. A summary of these drugs is presented in Table 16–1.

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Table 16–1   Anticoagulant and antiplatelet drugs. 

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