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CHEST 2022 Guidelines: Perioperative Management of Antithrombotic Therapy
CHEST Guidelines
Aug 5, 2025, 00:05

CHEST 2022 Guidelines: Perioperative Management of Antithrombotic Therapy

Dr. Chokri Ben Lamine, hematologist at King Faisal Specialist Hospital and Research Centre (KFSHRC), recently shared a post on X:

“Perioperative Management of Antithrombotic Therapy per CHEST 2022 Guidelines

1/ Key Color Code
Green: Continue
Orange: Individualize
Red: Stop
Always tailor by bleeding risk, CrCl, and surgery type!

2/ VKA (e.g. warfarin)
Continue until day -5 to -3
Restart PM of surgery day if no bleeding
Bridging? Only if high thrombotic risk

3/ DOACs (apixaban, edoxaban, rivaroxaban, dabigatran)
CrCl dependent!
Stop 2–3 days preop (longer if decreased CrCl or high bleeding)
Restart ~48–72h postop if low bleeding risk

4/ LMWH bridging
Don’t use for all patients!
Use if VKA held + high thrombotic risk
Last dose ≥24h preop
Resume Day 1–2 postop depending on bleeding

5/ Antiplatelets
•Aspirin: Y/N by bleeding risk and cardiac history
•Clopidogrel/Ticagrelor: Hold 5–7 days before
•Prasugrel: Hold at least 7 days preop
Restart Day 1–2 postop

6/ Fondaparinux:
Stop ~3 days preop
Restart Day 1–2 postop

7/ Key Reminders
Don’t restart anticoagulation until ≥24h post-op
High-risk surgery = longer hold
Multidisciplinary planning essential
Always consider CrCl + bleeding/thrombotic risk!

Source:
Douketis JD, et al. Chest. 2022;162(5):e207-e243.

© American College of Chest Physicians.
Credits: Dr. Hazzaa Alzahrani for sharing.”

CHEST

Stay updated on the latest with Hemostasis Today.

Antiplatelets Antithrombotic CHEST 2022 Chokri Ben Lamine DOAC Fondaparinux Guidelines Health Hematology Hemostasis Today KFSHRC LMWH Medicine Perioperative Management VKA
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