Table 4.

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

Therapy	Mechanism	Delivery route	Indication
Anticoagulant
Warfarin, phenprocoumon	Inhibition of vitamin K–dependent carboxylation of factors II, VII, IX, X	Oral	Prevention and treatment of venous and arterial thrombosis/thromboembolism
Unfractionated heparin, low-molecular-weight heparin	Activation of antithrombin	Intravenous or subcutaneous	Prevention and treatment of venous and arterial thrombosis/thromboembolism
Direct oral anticoagulants (direct thrombin or factor Xa inhibitors)	Inhibition of thrombin or factor Xa	Oral	Prevention and treatment of venous and arterial thrombosis/thromboembolism
Antiplatelet
Acetylsalicylic acid	Inhibition of cyclooxygenase	Oral	Secondary prophylaxis of infarction or ischemic stroke
Continuing acetylsalicylic acid before elective surgery	Inhibition of cyclooxygenase	Oral	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)
Thienopyridine	P2Y receptor antagonist	Oral	Secondary prophylaxis of infarction or ischemic stroke

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

^*Adapted from Mailer and colleagues⁶¹ and Alkhalil and colleagues.⁶²