Overall management recommendations
| How should acute venous thromboembolism be managed? |
| Direct oral anticoagulants are first-line treatment, but based on a weak recommendation |
| Low-molecular-weight heparin and warfarin are acceptable alternatives |
| Low-molecular-weight heparin is recommended for cancer-associated venous thromboembolism |
| Catheter-directed lysis should be considered for iliofemoral deep vein thrombosis. |
| Use heparin bridging if the patient is taking warfarin and needs surgery? |
| No for atrial fibrillation except for patients with CHADS2 > 4 or a recent stroke |
| Yes for patients with a mechanical heart valve, except consideration of not bridging for a patient with a bileaflet aortic valve replacement |
| Consider bridging for venous thromboembolism only within first 3 months of therapy. |
| How should patients be managed if they are taking direct oral anticoagulants and need surgery? |
| 2 days off for high risk of bleeding, 1 day off for low risk (longer for dabigatran and creatinine clearance rate < 50 mL/min) |
| Be careful with postoperative resumption of therapy |
| No need to bridge |
| How should patients with a coronary stent who need surgery be managed? |
| Wait at least 1 to 3 months after stent implantation |
| If cannot wait, consider continuing aspirin with or without a P2Y12 inhibitor, platelet transfusion |