This guideline addresses the management of patients who are receiving anticoagulant or antiplatelet therapy and require an elective surgery or procedure.
The methods herein follow those discussed in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. In patients requiring vitamin K antagonist VKA interruption before surgery, we recommend stopping VKAs 5 days before surgery instead of a shorter time before surgery Grade 1B.
In patients with a mechanical heart valve, atrial fibrillation, or VTE at high risk for thromboembolism, we suggest bridging anticoagulation instead of no bridging during VKA interruption Grade 2C ; in patients at low risk, we suggest no bridging instead of bridging Grade 2C.
In patients who require a dental procedure, we suggest continuing VKAs with an oral prohemostatic agent or stopping VKAs 2 to 3 days before the procedure instead of alternative strategies Grade 2C.
In moderate- to high-risk patients who are receiving acetylsalicylic acid ASA and require noncardiac surgery, we suggest continuing ASA around the time of surgery instead of stopping ASA 7 to 10 days before surgery Grade 2C. Perioperative antithrombotic management is based on risk assessment for thromboembolism and bleeding, and recommended approaches aim to simplify patient management and minimize adverse clinical outcomes.
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