Perioperative Management of Antithrombotics Flashcards
Nicholas Norgard, PharmD
Preoperative Anticoagulation Management
Thrombotic Risk Stratification: Atrial Fibrillation
Thrombotic Risk Stratification: Mechanical Heart Valves
Perioperative Antithrombotic Therapy
Thromboembolism Risk
Stroke Risk in Atrial Fibrillation
Estimating Risk of Perioperative Bleeding
Estimating Risk of Perioperative Bleeding
Interventional Spine and Pain Procedures
Estimating Risk of Perioperative Bleeding: Beyond the bleed risks inherent to a given procedure
Risk of Bleeding by HAS-BLED Score
Determine if Anticoagulation should be Interrupted: Interrupt Therapy
Determine if Anticoagulation should be Interrupted: Consider Interruption
Determine if Anticoagulation should be Interrupted: Do not Interrupt
Determine if Anticoagulation should be Interrupted: When to interrupt Warfarin
Determine if Anticoagulation should be Interrupted: DOAC Timing
Whether to Bridge Parenterally for Surgery
Bridging for UFH and LMWH
Sample Bridging for Warfarin and LMWH
Restarting Warfarin
Restarting DOAC
Neuraxial Anesthesia Heparin Guidelines
Neuraxial Anesthesia Warfarin and DOACs Guidelines
Case Vignette No. 1
High Risk/HAS BLED >3
Discontinue Warfarin 5 days before and bridge w/ LMWH ~3 days before
Post-Op
Restart Warfarin at 12-24 hours
Restart LMWH ~3 days
Case Vignette No. 2
High Risk Bleeding
Low Risk with A-fib (CHA2DS2-VASc score 1)
Discontinue apixaban therapy ~48-72 hours based on antiFXa results
Do not bridge
Post-Op
Restart apixaban therapy ~48-72 hours
Case Vignette No. 3
Coronary Stent <1 year Risk is High
Bridge with Cangrelor, LMWH, G2P3a
Stop Clopidogrel 5-7 days to let platelets regenerate
