I. Table 13. Guidelines for managing anticoagulation during procedures/surgeries.

Adapted from Nguyen DP, et al. Hosp Pharm 1999, and Mayo Clinic. Regional Anticoagulation Symposium, Rochester, Minnesota. 10/2000.

PROCEDURE/ SURGERY	BLEEDING RISK	DIAGNOSIS	THROMBO RISK	PROTOCOL
.		VTE/pulmonary emboli	.
NA	NA	--- Within 6 weeks	High	2†
NA	NA	--- 6 wks - 3 months	High	2
NA	NA	--- Recurrent	Low	5, SC heparin post op
.		Acute arterial emboli	.
NA	NA	--- Within 6 weeks	High	2
NA	NA	--- > 6 weeks	Low	NA
.		Non valvular atrial fibrillation (NVAF)	.
NA	NA	--- Uncomplicated	Low	5, SC heparin post op
NA	NA	--- With risk factors (1)	High	4, SC heparin post op
.		Mechanical heart valve prostheses	.
NA	NA	--- Low risk (2)	Low	5, SC heparin post op
NA	NA	--- High risk (3)	High	4, 2

• No detail in managing patients with different operative bleeding risk.
• Using protocols with post operative full dose heparin when there is low bleeding risk, or there is very high thromboembolic risk without anticoagulation.
• NA = Not available.
• † = Elective surgeries should be avoided in the first month after an acute venous or arterial thromboembolism. If the surgery is required within 2 weeks after an acute episode of venous thromboembolism and anticoagulation cannot be used, the patient should have venacaval filter inserted.
• (1) =>65 yo, history of TIAs, CVA, Systemic emboli, hypertension, severe LV systolic dysfunction, recurrent CHF, DM, rheumatic mitral valvular disease, thyrotoxicosis.
• (2) = St. Jude Medical bileaflet aortic valve, CarboMedics bileaflet aortic valve, Medtronic-Hall tilting disk aortic valve.
• (3) = History of TIAs, CVA, systemic emboli, severe LV systolic dysfunction, recurrent CHF, mitral position, multiple protheses.