Perioperative Management of Anticoagulation Therapy in Vascular Surgery: A Clinical Evaluation of Risks, Benefits, and Postoperative Complications

Objective To evaluate the safety and efficacy of perioperative anticoagulation therapy in patients undergoing vascular surgery, analyze the associated risks and benefits, and explore the influencing factors of postoperative complications. Methods A retrospective analysis was conducted on 100 patients who underwent vascular surgery and received perioperative anticoagulation therapy in our hospital from January 2023 to December 2024. According to the type of anticoagulant used, the patients were divided into two groups: the Novel Oral Anticoagulant (NOAC) group (n = 52) and the Vitamin K Antagonist (VKA) group (n = 48). The NOAC group was treated with dabigatran or rivaroxaban, while the VKA group was treated with warfarin. Perioperative management strategies included preoperative risk assessment, intraoperative anticoagulation monitoring, and postoperative dosage adjustment and complication prevention. The primary outcomes were the incidence of postoperative thromboembolic events and bleeding complications. Secondary outcomes included the length of hospital stay, coagulation function indexes (prothrombin time [PT], activated partial thromboplastin time [APTT], international normalized ratio [INR]), and mortality within 30 days after surgery. Results The total incidence of postoperative thromboembolic events in the 100 patients was 5.0% (5 cases), including 2 cases (3.8%) in the NOAC group and 3 cases (6.2%) in the VKA group, with no statistically significant difference between the two groups (P > 0.05). The total incidence of bleeding complications was 8.0% (8 cases), including 3 cases (5.8%) in the NOAC group and 5 cases (10.4%) in the VKA group, and the difference between the two groups was not statistically significant (P > 0.05). However, the NOAC group had a significantly shorter time to achieve stable anticoagulation effect (2.1 ± 0.8 days vs. 4.3 ± 1.2 days, P < 0.001) and a shorter length of hospital stay (7.5 ± 2.3 days vs. 9.8 ± 2.7 days, P < 0.001) compared with the VKA group. Multivariate logistic regression analysis showed that age ≥ 70 years, preoperative creatinine clearance rate < 60 mL/min, and surgical duration > 3 hours were independent risk factors for postoperative complications (P < 0.05). Conclusion Perioperative anticoagulation therapy with NOACs or VKAs can effectively reduce the risk of thromboembolic events in vascular surgery patients, with similar safety profiles in terms of bleeding complications. NOACs have advantages in terms of rapid onset of action and shorter hospital stay. Individualized perioperative management based on patient characteristics can further improve the safety and efficacy of anticoagulation therapy.