HelixTalk Episode #75 - Taking a break: perioperative management of anticoagulants and antiplatelets, Part II

Date posted: March 13, 2018, 6:00 am

In the previous episodes, we discussed how we should evaluate a patient’s bleeding and clotting risks as well as looked at recommendation for management for various anticoagulants. In this episode, we will continue the discussion to management of antiplatelets as well as when to resume both antiplatelets and anticoagulants following a procedure.

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Key Concepts

1. In procedures with very low bleeding risk (such as a minor dental procedure), aspirin is typically not held prior to the procedure.
2. In procedures with moderate-to-high risk of bleeding, antiplatelet therapy is usually held for 5-7 days in patients without an ASCVD history who are at low risk of future ASCVD events.  In patients with a history of ASCVD, especially in those with a recent cardiac stent, antiplatelet therapies are typically not held for a procedure.
3. Following a procedure with a moderate-to-high risk of bleeding, most anticoagulants and antiplatelet therapies can be resumed after 24-48 hours depending on the degree of post-operative hemostasis.  Consider that all anticoagulants and antiplatelets have a near immediate onset of action EXCEPT for warfarin, which can take several days to reach its full anticoagulant effect.

References

1. Douketis JD, Spyropoulos AC, Spencer FA, 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;141(2 Suppl):e326S-e350S. 
2. 2017 ACC Expert Consensus Decision Pathway for Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation. John U. Doherty, Ty J. Gluckman, William J. Hucker, James L. Januzzi, Thomas L. Ortel, Sherry J. Saxonhouse, Sarah A. Spinler. Journal of the American College of Cardiology. 2017; 69(7):871-898.