Joseph R. Shaw: Individualized Risk-Adapted Perioperative Anticoagulation Management for APS Is Feasible and Safe
Joseph R. Shaw, Director of Research+ Program at Ottawa Department of Medicine, EHJ-CVP Associate Editor of European Heart Journal, shared on LinkedIn about a recent article he and his colleagues co-authored, published in Blood Advances, adding:
”I’m pleased to share that our paper, ‘Perioperative management of antithrombotic therapy in patients with thrombotic antiphospholipid syndrome,’ has been published in Blood Advances.
This project grew out of a practical and difficult question we face often in thrombosis care: how should we manage anticoagulation interruption in patients with thrombotic APS who need surgery or an invasive procedure?
Data to guide these decisions is limited.
In this study, we evaluated 172 adults with thrombotic APS who underwent 282 planned perioperative anticoagulation interruptions between 2016 and 2025.
To our knowledge, this is the largest single-center cohort focused on perioperative anticoagulation management in thrombotic APS.
A few key findings stood out to me:
- Bridging was commonly used, and clinicians appeared to individualize management based on APS phenotype and prior thrombotic history.
- Patients with triple-positive APS and those with prior arterial thromboembolism were more likely to receive therapeutic-dose LMWH bridging.
Overall, 30-day outcomes were reassuring: the risks of arterial thromboembolism and major bleeding were both 0.7%, while clinically relevant nonmajor bleeding occurred in 3.2% of interruptions.
The take-home message: individualized, risk-adapted perioperative anticoagulation management that considers APS-related thrombotic risk, procedural bleeding risk, and clinical context appears feasible and safe in thrombotic APS.
At the same time, high-risk phenotypes – especially triple-positive APS and prior arterial events – still require careful planning and vigilance.
A special congratulations to Miguel Paquette.
This paper reflects his hard work, persistence, and attention to detail, and I’m very glad to see these important results published in Blood Advances.”
Title: Perioperative management of antithrombotic therapy in patients with thrombotic antiphospholipid syndrome
Authors: Miguel Paquette, Sébastien Miranda, Yan Xu, Leslie Skeith, Marcel Miron-Celis, Ronald A. Booth, Hakan Buyukdere, Deborah M. Siegal, Grégoire Le Gal, Marc Carrier, James D. Douketis, Jerrold H. Levy, Jean M. Connors, Aurélien Delluc, Joseph R. Shaw
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