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Anticoagulants in special populations

Session presentations
  • During pregnancy and puerperium. Presented by FWA Verheugt (Amsterdam, NL) See the slides
  • In patients undergoing device implantation or ablation. Presented by I Porto (Arezzo, IT) See the slides
  • In patients undergoing non-cardiac surgery. Presented by D C L Gulba (Kreuzau-Stockheim, DE) See the slides
  • In patients with chronic kidney disease. Presented by F Andreotti (Rome, IT) See the slides
Cardiovascular Pharmacology and Pharmacotherapy

This session was co-chaired by Prof GYH Lip (Birmingham, UK) and Prof D Milicic (Zagreb, Croatia) and dealt with areas which were not necessarily covered by guidelines, on the use of anticoagulation in difficult patient populations.

FWA. Verheught (the Netherlands) provided a discussion on the use of anticoagulation during pregnancy and the per-partum period.  Guidelines were mostly informed by cohort studies with lack of data from randomized trials.  Concerns with warfarin include those pertaining to the fetus, but overall such pregnancies have a high risk of complications.

I. Porto provided an excellent and highly detailed overview of anticoagulation in patients undergoing device implantation or ablation.  A very important message is that a bridging strategy is associated with a high risk of thromboembolism and bleeding. Bridging practice differs between North America and Europe [1].  During device implantation (or even ablation) there is increasing tendency for the procedure to be done whilst the patient is still anticoagulated with warfarin.  New oral anticoagulants offer some opportunities, but management needs to consider important aspects such as bleeding risk and renal function [2].  A high HAS-BLED score has been shown to be predictive of bleeding events in patients (both AF and non-AF) undergoing bridging [3].

D. Gulba (Germany) gave a presentation on anticoagulation in patients undergoing non-cardiac surgery.  He proposed the use of the CHA2DS2-VASc score to assess thromboembolic risk when anticoagulation was subtherapeutic, even in patients with valve disease, on the assumption that the risk was a linear one following cessation of anticoagulation, or when anticoagulation was subtherapeutic.  The CHA2DS2-VASc score is not validated for this purpose.

F. Andreotti (Italy) gave an overview on the use of parenteral and oral anticoagulation in chronic kidney disease, which is a pretty fragile population. Such patients can be at high risk of thromboembolism and death, but are also at high risk of bleeding [4].  In patients with atrial fibrillation, a management proposal balancing stroke and bleeding risk has been proposed [5].

1. Pisters R and Lip GYH.  Chest 2012
2. Pengo V et al. Thrombosis & Haemostasis 2011
3. Omran H et al. Thrombosis & Haemostasis 2012
4. Olesen J et al. New England Journal of Medicine 2012
5. Marinigh R et al. Journal of the American College of Cardiology 2011




Anticoagulants in special populations

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.