The Fellow on Call: The Heme/Onc Podcast Episode 133: VTE Series - Perioperative Anticoagulation Management and Emergent Reversal
Apr 9, 2025
Delve into the crucial considerations of managing anticoagulation during surgeries and emergencies. Learn the importance of holding and reversing anticoagulants in various clinical scenarios. The discussion emphasizes effective communication with patients and healthcare providers to ensure safety. Discover insights on using Indexanet alpha as a reversal agent and the complexities involved in individual patient care. This informative session balances technical expertise with relatable anecdotes, making it a must-listen for medical professionals.
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Procedural Holding Times
- Hold warfarin or fondaparinux for 5 days prior to procedures for safe washout.
- Hold DOACs for 1-2 days based on bleeding risk; surgeons' preferences may vary.
Selective Bridging Recommendations
- Most patients do not need bridging except those with recent or high-risk VTE.
- Delay procedures when possible for at least 3 months after a clot to reduce risk.
Clear Bridging Communication
- When bridging, outline the plan clearly with exact dates and dosing for no ambiguity.
- Use enoxaparin starting after the second or third missed anticoagulant dose based on warfarin or DOAC use.