Anticoagulation Management in the Perioperative Setting

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Footnotes:

* ACC EP council: Could be intermediate, but only under extreme circumstances. Otherwise would be low.

† As per the American Society of Regional Anesthesia and Pain Medicine, Bleeding risk of other regional nerve blocks is based on compressibility, patient body habitus, co-morbidities and the degree and duration of anticoagulation.

‡ Mechanical aortic valve even in the presence of major risk factors is considered to have a moderate thromboembolic risk, we believe a h/o previous thrombus should be included in the high risk category.

§ The consensus of the ACC was that this was a low intermediate risk. It was not as low as radial but certainly not in the same category as other intermediate procedures such as a pericardiocentesis. It would also depend on the sheath size and the patient’s body habitus.

¶ Some procedures are listed under different medical associations and given different estimates of bleeding risk. We recommend use clinical judgment and/or choose the procedure from the Med. Society of your preference.

# PEG on single agent (aspirin or clopidogrel) is low risk, Does not apply to DAPT (dual antiplatelet therapy).

Disclaimer: This tool is intended for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition.

References:

  1. Douketis JD. Perioperative Management of Anticoagulant Therapy. N Engl J Med Evid. 2023 May 23; DOI: 10.1056/EVIDra2200322.
  2. Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative Management of Antithrombotic Therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e326S-e350S. DOI: 10.1378/chest.11-2298.
  3. Doherty JU, Gluckman TJ, Hucker WJ, et al. 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients with Nonvalvular Atrial Fibrillation: A Report of the American College of Cardiology Clinical Document Committee. J Am Coll Cardiol. 2017 Feb 21;69(7):871-898. DOI: 10.1016/j.jacc.2016.11.024.
Developed by: Dr. Jose Luis Velazquez C.