| Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | |
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MedLine Citation:
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PMID: 22315266 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: This guideline addresses the management of patients who are receiving anticoagulant or antiplatelet therapy and require an elective surgery or procedure. METHODS: The methods herein follow those discussed in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines article of this supplement. RESULTS: In patients requiring vitamin K antagonist (VKA) interruption before surgery, we recommend stopping VKAs 5 days before surgery instead of a shorter time before surgery (Grade 1B). In patients with a mechanical heart valve, atrial fibrillation, or VTE at high risk for thromboembolism, we suggest bridging anticoagulation instead of no bridging during VKA interruption (Grade 2C); in patients at low risk, we suggest no bridging instead of bridging (Grade 2C). In patients who require a dental procedure, we suggest continuing VKAs with an oral prohemostatic agent or stopping VKAs 2 to 3 days before the procedure instead of alternative strategies (Grade 2C). In moderate- to high-risk patients who are receiving acetylsalicylic acid (ASA) and require noncardiac surgery, we suggest continuing ASA around the time of surgery instead of stopping ASA 7 to 10 days before surgery (Grade 2C). In patients with a coronary stent who require surgery, we recommend deferring surgery > 6 weeks after bare-metal stent placement and > 6 months after drug-eluting stent placement instead of undertaking surgery within these time periods (Grade 1C); in patients requiring surgery within 6 weeks of bare-metal stent placement or within 6 months of drug-eluting stent placement, we suggest continuing antiplatelet therapy perioperatively instead of stopping therapy 7 to 10 days before surgery (Grade 2C). CONCLUSIONS: Perioperative antithrombotic management is based on risk assessment for thromboembolism and bleeding, and recommended approaches aim to simplify patient management and minimize adverse clinical outcomes. |
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Authors:
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James D Douketis; Alex C Spyropoulos; Frederick A Spencer; Michael Mayr; Amir K Jaffer; Mark H Eckman; Andrew S Dunn; Regina Kunz; |
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Publication Detail:
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Type: Journal Article; Practice Guideline |
Journal Detail:
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Title: Chest Volume: 141 ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-02-08 Completed Date: 2012-04-13 Revised Date: 2013-05-20 |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: e326S-50S Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, McMaster University, Hamilton, ON, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Balloon, Coronary Aspirin / adverse effects, pharmacokinetics, therapeutic use Atrial Fibrillation / blood, complications, drug therapy Drug Administration Schedule Evidence-Based Medicine* Fibrinolytic Agents / administration & dosage*, adverse effects*, pharmacokinetics Heart Valve Prosthesis Humans Perioperative Care* Platelet Aggregation Inhibitors / administration & dosage*, adverse effects*, pharmacokinetics Postoperative Complications / blood, drug therapy, prevention & control Risk Factors Societies, Medical* Stents Surgical Procedures, Elective* Thrombosis / blood, drug therapy*, prevention & control* United States Vitamin K / antagonists & inhibitors |
| Grant Support | |
ID/Acronym/Agency:
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UL1 TR000077/TR/NCATS NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors; 12001-79-5/Vitamin K; 50-78-2/Aspirin |
| Comments/Corrections | |
Erratum In:
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Chest. 2012 Apr;141(4):1129 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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