Guideline in Focus
Perioperative Management of Antithrombotic Therapy

Our multidisciplinary expert panel has developed recommendations for the management of patients who are receiving long-term oral anticoagulant or antiplatelet therapy and require an elective surgery or procedure.

This guideline addresses the use of vitamin K antagonists (VKAs) like warfarin, perioperative heparin bridging, direct oral anticoagulants (DOACs), and antiplatelet drugs like aspirin (ASA).

PUBLISHED August 11, 2022

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Key Recommendations

In patients receiving VKA therapy for a mechanical heart valve who require VKA interruption for an elective surgery or procedure, we suggest against heparin bridging.

In patients receiving VKA therapy for atrial fibrillation who require VKA interruption for an elective surgery or procedure, we recommend against heparin bridging.

In patients who require DOAC interruption for an elective surgery or procedure, we suggest against perioperative heparin bridging.

In patients receiving ASA who are undergoing elective noncardiac surgery, we suggest ASA continuation over ASA interruption.


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- days
Stop VKA before bleed
risk procedures
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Resume VKA post-bleed
risk procedures
hours
Resume DOAC post-low/post-moderate bleed risk procedures
- hours
Resume DOAC post-high bleed risk procedures

Implement this guideline into practice

Our guidelines are aimed at helping you respond to today’s clinical challenges and improve patient health outcomes. Our panel of experts has developed multimedia content to facilitate adoption of this guideline into your day-to-day practice.


PRESS RELEASE

CHEST releases a clinical practice guideline on perioperative management of antithrombotic therapy
In a release issued to the media, lead author, James D. Douketis, MD, speaks to the importance of this guideline in practice. An update to the 2012 Perioperative Management of Antithrombotic Therapy guideline, the new guideline is more comprehensive, containing 43 population, intervention, comparator, and outcome questions.

3-MINUTE READ

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