Periprocedural Antithrombotic Therapy: A Practical Guide for Clinical Practice

ABSTRACT More than 6 million patients are on anticoagulant therapy and more than one third of adults take antiplatelet therapy in the United States, many of whom will require a surgical procedure while on treatment. The answers to questions regarding periprocedural thrombotic therapy are not at all straightforward and there is tremendous variability in practice across the country and across specialties. While there will always be nuances in clinical care that necessitate variation in practice patterns, algorithms for care allow for less ambiguity and they provide guidelines that are consistent with the most recent evidence in the literature. In this review, we provide: 1) a framework for periprocedureal antithrombotic therapy around the time of surgical procedures, 2) an approach for considering the risk of bleeding at the time of surgery as well as the risk of a thrombotic or thromboembolic event should the antithrombotic therapy be stopped, and 3) a strategy for managing periprocedural bridging therapy.