Development of an Institutional Periprocedural Management Guideline for Oral Anticoagulants

Abstract

Patients on oral anticoagulation commonly undergo surgery or other invasive procedures. Periprocedural management of oral anticoagulants involves a careful balance of the thromboembolic risk and bleeding risk. To standardize clinical practice at our institution, we developed a guideline for periprocedural management for patients taking oral anticoagulants that incorporates published data and expert opinion. In this article, we present our clinical practice guideline as a decision support tool to aid clinicians in developing a consistent strategy for managing periprocedural anticoagulation and for safely bridging anticoagulation in patients who require it.

A Review of Direct-acting Oral Anticoagulants and Their Use in Solid Organ Transplantation

“…46 For patients on DOACs, the duration of hold before surgery ranges from 2 to 5 d (Table 2) depending on the pharmacokinetics of the agent and the renal function of the transplant recipient. 21,46,47 Patients at a high risk of thromboembolism during interruption of anticoagulation may either require a transition from an oral to a parenteral anticoagulant as an outpatient using LMWH or may require admission to the hospital for IV CI UFH before surgery. 48,49 For patients on a DOAC, bridging with a parenteral agent is generally not required because of the short half-lives of the agents.…”

“…46 For patients on DOACs, the duration of hold before surgery ranges from 2 to 5 d (Table 2) depending on the pharmacokinetics of the agent and the renal function of the transplant recipient. 21,46,47…”