Editing CUA: VTE Prophylaxis (2019) (section)

== Recommendations for bridging of anticoagulation and antiplatelet agents ==

* '''See Table (no direct link available) from Original Guideline on summary of CUA recommendations for peri-procedure management of anticoagulants and antiplatelet agents'''
* '''Patients are considered to be at very high risk of thrombosis if any 1 of the following are present:'''
*# '''Drug-eluting stent placement within 6 months'''
*# '''Bare metal stent placement within 6 weeks'''
*# '''Transient ischemic attack (TIA) stroke within 30 days'''
*# '''New incidence of VTE within 1 month'''
*# '''Severe thrombophilia (such as antithrombin deficiency, antiphospholipid antibody, or other as identified by appropriate specialist)'''
*# '''Cage-ball mechanical heart valves'''
* '''In patients receiving an antiplatelet agent (e.g. aspirin, clopidogrel, ticagrelor) who do not have a very high risk of thrombosis (see above) the panel recommends stopping antiplatelet agents 7 days prior to surgery without bridging and restarting antiplatelet therapy 4 days post-surgery as compared to a longer period off therapy'''
* '''In patients receiving an anticoagulant agent (see example below) who do not have very high risk of thrombosis, the panel recommends stopping prior to surgery without bridging therapy and restarting 4 days post-surgery as compared to a longer period off therapy. The recommended duration off anticoagulation prior to surgery varies by therapy as follows:'''
** '''Direct oral anti-coagulant (DOAC) (dabigatran, apixaban, edoxaban, rivaroxaban) 3 days prior;'''
*** '''Note: Renal function may affect DOAC clearance and prolong anticoagulant activity. For patients with impaired renal function, DOAC may need to be stopped longer than 3 days prior to surgery.'''
** '''Warfarin 5 days prior'''
** '''LMWH (therapeutic dosing) 12 hours (if twice daily dosing) or 24 hours (if once daily dosing) prior'''
** '''Fondaparinux 24 hours prior'''
* '''Patients at very high risk of thrombosis in whom surgery can be delayed until the period of very high risk is completed should have surgery delayed until the period of very high risk is over'''
* '''For patients at very high risk of thrombosis in whom surgery cannot be delayed, our panel recommends multidisciplinary discussion and an individualized treatment plan'''