New anticoagulant drugs: monitoring and perioperative strategies.

Arterial and venous thromboses are major causes of mortality and morbidity. In Western countries, more than 1% of the population takes an antithrombotic agent. Many of these patients will need to undergo surgery and decisions need to be made regarding whether to continue their antithrombotic medication and risk increased bleeding or to stop it and potentially increase the risk of thrombosis. Anaesthesiologists, therefore, need to be aware of the basic pharmacology of the available agents as well as their individual indications, contraindications, and adverse effects. In this review we will discuss these aspects, and also discuss new antithrombotic agents that are currently being developed to improve efficacy and to increase safety in comparison with conventional agents. New coagulation monitoring devices will also be discussed.