Perioperative management of patients receiving anticoagulants and antiplatelet agents. Clinical practice recommendations of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists” and the non-profit corporate organization “National Association of Specialists in Thrombosis, Clinical Hemostasis and Hemorheology”. Revision 2025

Perioperative management of patients receiving anticoagulants and antiplatelet agents is a complex task that requires a balance between the risk of thromboembolic complications and the risk of bleeding. Due to the increasing number of patients taking antithrombotic drugs, the relevance of developing modern recommendations for their perioperative management increases. Particular attention is paid to patients with comorbidities such as atrial fibrillation, ischemic stroke, myocardial infarction and coronary stenting. The article presents the guidelines of the Federation of Anesthesiologists and Reanimatologists and the National Association of Specialists in Thrombosis, Clinical Hemostasis and Hemorheology for the management of patients receiving anticoagulants and antiplatelet agents, revised in 2025. The guidelines for the perioperative management of patients receiving anticoagulants and antiplatelet agents have been updated, taking into account modern concepts of the risks of thromboembolism and bleeding. Particular attention focused to risk stratification, interruption and resumption of antithrombotic therapy, and the safety of regional anesthesia during anticoagulant therapy. The recommendations use data from modern studies, meta-analyses, and clinical trials on the perioperative management of patients receiving anticoagulants and antiplatelet agents. Various methods of thromboprophylaxis are considered, including the use of low molecular weight heparins, fondaparinux, and other anticoagulants. Particular attention is paid to risk stratification using the Caprini, HAS-BLED, and CHA2DS2-VASc scales. Recommendations are proposed for interruption and resumption of antithrombotic therapy depending on the risk of thromboembolism and bleeding. Criteria for the quality of compliance with recommendations, as well as algorithms for patient management during elective and emergency surgeries, are developed. The guidelines provide clinicians with practical tools to manage perioperative risk in patients receiving anticoagulants and antiplatelet agents. An important aspect is the individual approach to each patient, taking into account their clinical situation and risks.