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The perioperative management of patients who are receiving antithrombotic therapy is based on an assessment of patient risk for thromboembolism and perioperative bleeding. Addressing these issues will determine whether antithrombotic therapy is interrupted around the time of surgery and, if so, whether bridging anticoagulation is considered.
To date, there are no validated risk stratification schemes to reliably separate VKA-treated patients into risk strata for thromboembolism and bleeding. Recommendations are based largely on indirect evidence and clinical experience and are meant to provide general guidance. Ultimately, patient management may vary depending on individual patient characteristics, the surgery and patient values and preferences.
Perioperative Management of Antithrombotic Therapy: Antithrombotic Therapy and Prevention of Throbosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141;e326S-e350S
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