Safety of liver resection in patients receiving antithrombotic therapy: A systematic review of the literature

Figure 2 Recommended perioperative management protocol for patients undergoing antithrombotic therapy in case of hepatobiliary-pancreatic and gastrointestinal surgery. The management generally consists of 3 ways according to types of antithrombotic therapy; antiplatelet therapy, warfarin, and direct-acting oral anticoagulant (DOACs). In patients with thromboembolic risks, aspirin monotherapy is continued in patients receiving antiplatelet therapy, and warfarin is substituted by DOAC bridging (preferred) or heparin bridging. In case of DOAC, short-period discontinuation of DOACs (usually 1-2 d) without heparin bridging is generally recommended (with some modification needed if decreased renal function exists). Postoperatively, every antithrombotic agent is reinstituted as soon as possible (POD1-2). DOAC: Direct-acting oral anticoagulant.