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Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline.

Publication ,  Journal Article
Douketis, JD; Spyropoulos, AC; Murad, MH; Arcelus, JI; Dager, WE; Dunn, AS; Fargo, RA; Levy, JH; Samama, CM; Shah, SH; Sherwood, MW; Tafur, AJ ...
Published in: Chest
November 2022

BACKGROUND: The American College of Chest Physicians Clinical Practice Guideline on the Perioperative Management of Antithrombotic Therapy addresses 43 Patients-Interventions-Comparators-Outcomes (PICO) questions related to the perioperative management of patients who are receiving long-term oral anticoagulant or antiplatelet therapy and require an elective surgery/procedure. This guideline is separated into four broad categories, encompassing the management of patients who are receiving: (1) a vitamin K antagonist (VKA), mainly warfarin; (2) if receiving a VKA, the use of perioperative heparin bridging, typically with a low-molecular-weight heparin; (3) a direct oral anticoagulant (DOAC); and (4) an antiplatelet drug. METHODS: Strong or conditional practice recommendations are generated based on high, moderate, low, and very low certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology for clinical practice guidelines. RESULTS: A multidisciplinary panel generated 44 guideline recommendations for the perioperative management of VKAs, heparin bridging, DOACs, and antiplatelet drugs, of which two are strong recommendations: (1) against the use of heparin bridging in patients with atrial fibrillation; and (2) continuation of VKA therapy in patients having a pacemaker or internal cardiac defibrillator implantation. There are separate recommendations on the perioperative management of patients who are undergoing minor procedures, comprising dental, dermatologic, ophthalmologic, pacemaker/internal cardiac defibrillator implantation, and GI (endoscopic) procedures. CONCLUSIONS: Substantial new evidence has emerged since the 2012 iteration of these guidelines, especially to inform best practices for the perioperative management of patients who are receiving a VKA and may require heparin bridging, for the perioperative management of patients who are receiving a DOAC, and for patients who are receiving one or more antiplatelet drugs. Despite this new knowledge, uncertainty remains as to best practices for the majority of perioperative management questions.

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Published In

Chest

DOI

EISSN

1931-3543

Publication Date

November 2022

Volume

162

Issue

5

Start / End Page

e207 / e243

Location

United States

Related Subject Headings

  • Respiratory System
  • Platelet Aggregation Inhibitors
  • Physicians
  • Humans
  • Heparin
  • Fibrinolytic Agents
  • Anticoagulants
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Douketis, J. D., Spyropoulos, A. C., Murad, M. H., Arcelus, J. I., Dager, W. E., Dunn, A. S., … Moores, L. K. (2022). Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline. Chest, 162(5), e207–e243. https://doi.org/10.1016/j.chest.2022.07.025
Douketis, James D., Alex C. Spyropoulos, M Hassan Murad, Juan I. Arcelus, William E. Dager, Andrew S. Dunn, Ramiz A. Fargo, et al. “Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline.Chest 162, no. 5 (November 2022): e207–43. https://doi.org/10.1016/j.chest.2022.07.025.
Douketis JD, Spyropoulos AC, Murad MH, Arcelus JI, Dager WE, Dunn AS, et al. Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline. Chest. 2022 Nov;162(5):e207–43.
Douketis, James D., et al. “Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline.Chest, vol. 162, no. 5, Nov. 2022, pp. e207–43. Pubmed, doi:10.1016/j.chest.2022.07.025.
Douketis JD, Spyropoulos AC, Murad MH, Arcelus JI, Dager WE, Dunn AS, Fargo RA, Levy JH, Samama CM, Shah SH, Sherwood MW, Tafur AJ, Tang LV, Moores LK. Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline. Chest. 2022 Nov;162(5):e207–e243.

Published In

Chest

DOI

EISSN

1931-3543

Publication Date

November 2022

Volume

162

Issue

5

Start / End Page

e207 / e243

Location

United States

Related Subject Headings

  • Respiratory System
  • Platelet Aggregation Inhibitors
  • Physicians
  • Humans
  • Heparin
  • Fibrinolytic Agents
  • Anticoagulants
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences