Three step process for guidance
(1) Identify the thrombotic risk off anticoagulant as low-moderate or high
(2) Identify the surgical bleeding risk as minimal, low or moderate, or high
(3) Interrupt and resume Warfarin, using bridging heparin as directed, per visual schematic guidance
The ACC presents their guidance on VKA interruption as a calendar-based chart of days approaching surgery, the day of surgery, and days following surgery, similar to how the DOAC guidance was developed by Douketis in the PAUSE trial and its subsequent presentations.
In this app, the overall approach to VKA adapted from the ACC guideline is shown for all cases, with the user's attention focused to the particular patient case after identifying thrombotic and procedural risks. This should afford more familiarity with overall scheme while providing detailed case-specific instructions.
Identifying thrombotic risk lets you consider how risky it is to interrupt anticoagulation at all.
Identifying surgical bleeding risk lets you consider how risky it is to have any anticoagulant effect in the patient at the time of surgery.
The interruption scheme for warfarin, sometimes involving bridging heparins, then follows once thrombotic and surgical bleeding risk are categorized.