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.”
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