Two strong recommendations developed against use of heparin bridging in a-fib, and for continuation of VKA in patients getting pacemaker/ICD
TUESDAY, Sept. 20, 2022 (HealthDay News) — In a clinical practice guideline issued by the American College of Chest Physicians and published online Aug. 11 in CHEST, recommendations are presented for perioperative management of patients receiving long-term oral anticoagulant or antiplatelet therapy who require surgery.
James D. Douketis, M.D., from St. Joseph’s Healthcare Hamilton and McMaster University in Canada, and colleagues developed guidelines addressing 43 patient-intervention-comparator-outcome questions relating to perioperative management of patients receiving long-term oral anticoagulant or antiplatelet therapy who need an elective surgery or procedure.
The researchers developed 44 guideline recommendations, of which two were strong recommendations. For patients with atrial fibrillation, there was a strong recommendation against use of heparin bridging, and for patients having implantation of a pacemaker or internal cardiac defibrillator (ICD), vitamin K antagonist therapy should be continued. The authors also developed separate recommendations relating to perioperative management of patients undergoing minor procedures, including dental, dermatological, ophthalmological, pacemaker/ICD implantation, and endoscopic procedures.
“For perioperative antithrombotic management, it’s very important to have standardized approaches and protocols to limit variability in practice and, in turn, to minimize preventable bleeding and thrombotic events,” Douketis said in a statement. “These guidelines are also practical, providing clinicians with ‘how to’ approaches for managing patients on warfarin, direct oral anticoagulants, and antiplatelet drugs who are undergoing a wide array of surgeries and procedures as well as those who may need heparin bridging.”
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