Table 4

Summary of traditional antithrombotic therapies for use in elective surgical management of inherited bleeding disorders*

TherapyMechanismDelivery routeIndication
Anticoagulant
Warfarin, phenprocoumonInhibition of vitamin
K–dependent carboxylation of factors II, VII, IX, X		OralPrevention and treatment of venous and arterial thrombosis/thromboembolism
Unfractionated heparin, low-molecular-weight heparinActivation of antithrombinIntravenous or subcutaneousPrevention and treatment of venous and arterial thrombosis/thromboembolism
Direct oral anticoagulants (direct thrombin or factor Xa inhibitors)Inhibition of thrombin or factor XaOralPrevention and treatment of venous and arterial thrombosis/thromboembolism
Antiplatelet
Acetylsalicylic acidInhibition of cyclooxygenaseOralSecondary prophylaxis of infarction or ischemic stroke
Continuing acetylsalicylic acid before elective surgeryInhibition of cyclooxygenaseOral

  • Major bleed RR 1.31 (95% CI 1.15–1.50)

  • Stroke RR 1.00 (NS)

  • Major thromboembolic event RR 0.75 (95% CI 0.59–0.95)

  • Myocardial infarction RR 1.05 (NS)

ThienopyridineP2Y receptor antagonistOralSecondary prophylaxis of infarction or ischemic stroke

  • CI = confidence interval; NS = nonsignificant; RR = relative risk.

  • ↵* Adapted from Mailer and colleagues61 and Alkhalil and colleagues.62