Up to 20% of patients taking antithrombotic medications will need an invasive procedure. The American College of Chest Physicians published updated guidelines on perioperative management of antithrombotic medications for elective procedures based on a systematic review of primarily low-quality evidence.

Balance of Risks

The risk of bleeding following a procedure and the risk of thromboembolism from the initial need for antithrombotic treatment are the two factors used to determine whether and how long to hold medications. Table 1 stratifies common surgeries by bleeding risk. For procedures with minimal bleeding risk, the antithrombotic medication can generally be continued. For low- to moderate- or high-bleeding risk, most medications are stopped before surgery and later restarted. Patient or surgical factors may increase bleeding risk.