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Perioperative Thrombotic Risk Guide for Hematology Fellows
Aug 14, 2025, 04:03

Perioperative Thrombotic Risk Guide for Hematology Fellows

Chokri Ben Lamine, Adult Hematology and Stem Cell Transplantation Assistant Consultant at Oncology Center of Excellence at King Faisal Specialist Hospital & Research Center, shared a post on X:

“Perioperative Thrombotic Risk – Quick Guide for Hema Fellows

High Risk (>10%/mo VTE or >10%/yr ATE)

Recent (<3 mo) VTE
Strong thrombophilia (Protein C/S def., ATIII def., homozygous FVL/PGM, multiple thrombophilias)
APS
High-risk cancer: pancreas, brain, stomach, esophagus, myeloproliferative
AF: CHA₂DS₂-VASc ≥7, recent (<3 mo) stroke/TIA, rheumatic valve
Mechanical valve: MVR w/ major stroke RF, caged-ball/tilting-disc (any position), recent stroke/TIA

Moderate Risk (4–10%/mo VTE or 4–10%/yr ATE)

VTE within 3–12 mo
Recurrent VTE
Non-strong thrombophilia (heterozygous FVL/PGM)
Non-high-risk cancer VTE
AF: CHA₂DS₂-VASc 5–6
Mechanical valve: MVR w/o major stroke RF, bileaflet AVR w/ major stroke RF

Low Risk (<4%/mo VTE or <4%/yr ATE)

VTE >12 mo ago
AF: CHA₂DS₂-VASc 1–4
Mechanical valve: bileaflet AVR w/o major stroke RF

MCQ

Q: A 65-year-old with AF (CHA₂DS₂-VASc = 6) and VTE 8 months ago is scheduled for elective surgery. Perioperative thrombotic risk?
A) High
B) Moderate
C) Low

Answer: B) Moderate
Explanation: CHA₂DS₂-VASc = 6 → moderate AFib risk; VTE within 3–12 months → moderate VTE risk.

OSCE Scenario

Station: Pre-op anticoagulation planning for high-risk VTE
Prompt: 55-year-old with recent (<3 mo) DVT on warfarin, elective colectomy scheduled.

Tasks:
Identify thrombotic risk category (High)
Discuss bridging anticoagulation plan with LMWH
Outline timing for last LMWH dose before surgery and restart post-op
Counsel on bleeding vs thrombosis risk
Key points for examiner:

Recognize high risk → needs bridging

Stop warfarin 5 days pre-op

Last therapeutic LMWH 24 h pre-op

Credits to ASH SAP 9th edition ”

Perioperative Thrombotic Risk Guide for Hematology Fellows

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AF APS ASH SAP ATIII deficiency AVR bleeding brain caged-ball cancer CHA₂DS₂-VASc Chokri Ben Lamine colectomy DVT esophagus Health Hematology Hemostasis Today homozygous FVL King Faisal Specialist Hospital & Research Center LMWH mechanical valve Medicine MVR myeloproliferative Oncology Center of Excellence pancreas PGM Protein C deficiency Protein S deficiency RF rheumatic valve stomach stroke Thrombophilia thrombosis TIA tilting-disc VTE Warfarin
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