Can Anticoagulation Be Safely Continued in Most Otolaryngologic/Head and Neck Surgery?

BACKGROUND

Antithrombotic management is a key component of surgical optimization, as it necessitates balancing the risk of a peri-operative thrombotic event with the risk of bleeding. This is a common consideration for head and neck surgeons, as the patient population taking either antiplatelet or antithrombotic therapy can comprise a significant proportion of patients undergoing head and neck surgery—up to 75%, as one randomized trial from the University of Munich found. Suspension of antithrombotic therapy must carefully consider patient risk factors, including indication for antithrombotic medication, comorbidities, and metabolic capability, as well as procedural-specific risk of bleeding and potential sequelae. As head and neck procedures are often either high bleeding risk—defined as >1.5% risk—or high risk for serious sequelae of the brain, eye, or airway, proper peri-operative management of these medications is crucial.

BEST PRACTICE

Patients on antithrombotic therapy are frequently encountered in head and neck surgery, and the risk of continuing these medications can have rare but potentially devastating consequences. Most otolaryngologic procedures should be considered “high risk,” not only for classically extensive soft tissue surgeries but also for simpler procedures with exposed wounds or risk of life-threatening complications due to bleeding. Therefore, most otolaryngologic procedures necessitate some suspension of non-antiplatelet antithrombotic therapy, balancing patient and procedural risk factors; however, antithrombotic medications can be stopped within a reasonable time frame with respect to their pharmacologic properties and often resumed within 24 hours to minimize the risk of bleeding without increasing the risk of arterial or venous thromboembolism.