The Curbsiders Internal Medicine Podcast #425 Perioperative Management of Antithrombotics with Dr. Poorvi Hardman
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Feb 5, 2024 AI Snips
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Two-Factor Stratification For Periop Planning
- Stratify patients by procedure bleeding risk and patient thromboembolic risk before planning perioperative antithrombotic management.
- Use those two factors to decide whether to continue, hold, or bridge anticoagulation.
Three Buckets Simplify Decisions
- Group patients into three buckets: continue anticoagulation, hold without bridging, or hold with bridging.
- High thromboembolic risk + moderate/high bleeding risk usually warrants bridging decisions in bucket three.
Bridge Only High-Risk Patients
- Only bridge anticoagulation for patients at high thromboembolic risk; avoid routine bridging for most DOAC users.
- Reserve bridging when surgery timing is uncertain or patient has very high thrombotic risk.