Surgical and procedural bleed risk stratification for anticoagulated patients undergoing planned surgery: guidance from the ISTH SSC Subcommittee on Perioperative and Critical Care Thrombosis and Hemostasis

Patients often need to interrupt anticoagulation for invasive procedures or surgery. Periprocedural bleeding can contribute to substantial morbidity and mortality. Procedural bleed risk stratification informs whether anticoagulation needs to be interrupted, for how long, and when to restart anticoagulation post-procedure. Guidance on procedure-specific bleed risk varies and contributes to discordant perioperative anticoagulation management. To address this important knowledge gap, the Perioperative and Critical Care Thrombosis and Hemostasis Subcommittee of the International Society on Thrombosis and Haemostasis undertook a review of contemporary procedural bleed risk stratification schemas and developed a practical bleed risk stratification approach for use in anticoagulated adult patients having a planned elective surgery or procedure.