MAPPP 1.2.71

Despite the significant effectiveness of antithrombotic medications and the growing availability of oral anticoagulants, preventable bleeding and thrombotic events remain unacceptably common. Newly introduced agents may require less frequent laboratory monitoring; however, challenges persist in the clinical management of anticoagulated patients, especially during the peri-procedural period.

Surgical procedures and invasive medical interventions elevate the risk of bleeding, while discontinuing anticoagulants raises the risk of thrombosis given the initial indication for anticoagulation. Hence, the clinical team faces the crucial task of balancing these risks and making informed decisions regarding interrupting oral anticoagulation for medical procedures. Furthermore, if interruption is deemed necessary, the choice of whether to "bridge" anticoagulation with injectable agents like low molecular weight heparin (LMWH) in patients on warfarin must be carefully considered.

This comprehensive guide aims to:

• Assist healthcare providers in evaluating both procedure-related bleeding risks and underlying thrombosis risks simultaneously
• Offer guidance on decisions concerning anticoagulation interruption and the utilization of anticoagulant "bridging"
• Provide detailed recommendations on drug dosing and laboratory monitoring during the peri-procedural phase
• Promote clear communication among clinicians responsible for prescribing anticoagulants and carrying out invasive procedures

This resource was developed by the interdisciplinary Peri-Procedural Task Force of the New York State Anticoagulation Coalition and IPRO, which serves as the Medicare Quality Improvement Organization for New York State. The project was undertaken under contract with the Centers for Medicare & Medicaid Services (CMS), an agency within the U.S. Department of Health and Human Services. Please note that the contents do not necessarily represent CMS policy. Reference: 10SOW-NY-AIM-7.3-14-01