Anticoagulation and minor procedures (2022)

[Keywords: warfarin coumadin lovenox ]

Summary:

Interruption of anticoagulation is no longer recommended for most dental, dermatologic and ophthalmologic procedures.

Details:

The Clinical Pharmacy team would like to share the updated GLFHC Anticoagulation Protocol and the CHEST 2022 Guidelines for Perioperative Management of Antithrombotic Therapy

Here are a few anticoagulation peri-procedural pearls:

•    For most dental, minor dermatologic, & ophthalmologic procedures, CHEST guidelines recommend NOT interrupting anticoagulation.

•    Stronger evidence AGAINST enoxaparin (LMWH) bridging for many cases except for patients with highest thromboembolic risk.

•    For DOACs, time to hold depends on if the procedure/surgery is high or low bleed risk and on patient's renal function. Although apixaban (Eliquis) and rivaroxaban (Xarelto) are only renally excreted 25 & 33% respectively. 

A great resource for anticoagulation is Michigan Anticoagulation Quality Improvement Initiative (MAQI) Toolkit . Pages 42-48 help with warfarin periprocedural management and 70-74 for DOAC periprocedural management. 

Clinicians +/- pertinent specialists are responsible for evaluating individual patients' thromboembolic and bleed risk. Our clinical pharmacists can offer recommendations based on evidence and risk assessment to coordinate periprocedural management between specialists and the primary care team!