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Topics:
General Internal Medicine • Thrombosis • Hematology • Benign Hematology • Hemostasis/Thrombosis • Pulmonary Embolus
How do you manage perioperative anticoagulation for a patient with a history of recent, surgically provoked VTE?
Repeat surgery is planned 3 months after the index event, which included PE. Patient is anticoagulated with a DOAC.
Is there a benefit to perioperative bridging or switching to enoxaparin from alternative therapies like DOACs? Do risk models like the Caprini score help your decision-making, such as when thrombosis risk is predicted to be high?
Answer from: Medical Oncologist at Community Practice
In most cases, bridging is rarely indicated because the bleeding risk usually outweighs the risk of VTE recurrence during a short (1–2 day) interruption of anticoagulation. However, after a recent VTE (defined as <3 months), the estimated risk of VTE recurrence is high (>15–20% per year) (...
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