Perioperative Anticoagulation/Hemostasis Plan

Date/Time Authored: [MM/DD/YYYY HH:MM]

Procedure: [Procedure name]; [Scheduled date/time]; [Location]

Proceduralist: [Name, credential]

Anesthesia Type: [general / neuraxial / regional / MAC / TBD]

Authoring Service: [Service or clinician name]

Primary Question(s): [Anticoagulant hold and restart timing / Need for bridging / Neuraxial constraints / Hemostatic support]

Actionable Plan Summary

Bottom line: [Continue anticoagulation without interruption / Interrupt anticoagulation—last dose [Drug] at [MM/DD/YYYY HH:MM]].

Bridging: [Yes / No]—[One-line rationale referencing thrombotic vs bleeding risk].

Anesthesia constraints: [Neuraxial/regional timing requirements / Not applicable].

Restart: [Earliest anticipated restart timing]; resume when hemostasis confirmed and proceduralist approves. Responsible party: [Role/Service].

Owner of updates: [Service/Clinician] owns updates if procedure time or anesthesia plan changes.

Mini-table (key steps):

• Last dose: [Drug name/dose] | [MM/DD/YYYY HH:MM (D-#)] | [Hold interval rationale] | [Responsible party]

• Pre-op lab(s): [INR / CBC / BMP / Anti-Xa] | [MM/DD/YYYY (D-#)] | [Target values; action thresholds] | [Responsible party]

• Day-of management: [None / Hold dose / Heparin gtt stop time / Reversal agent] | [MM/DD/YYYY HH:MM (D0)] | [Notes] | [Responsible party]

• Neuraxial catheter: [Placement/removal timing] | [MM/DD/YYYY HH:MM] | [Required interval before/after anticoagulant dosing] | [Responsible party] (Omit row if not applicable.)

• Restart: [Drug and dose] | [Earliest MM/DD/YYYY HH:MM (POD#)] | [Conditions: hemostasis confirmed; proceduralist approval; neuraxial constraints satisfied] | [Responsible party]

Risk Assessment

Bleeding Risk: [minimal / low / moderate / high / critical-site]—[Brief rationale: tissue planes, vascularity, consequences of bleeding].

Patient-specific bleeding modifiers: [Prior surgical bleeding / Concurrent antiplatelets or NSAIDs / Thrombocytopenia / Liver disease / Renal impairment / None identified] (Include only relevant modifiers.)

Thrombotic Risk: [Indication: AF / VTE / Mechanical valve / Post-PCI/ACS / Other]—[Key modifiers: CHA₂DS₂-VASc score if AF; date and provoked/unprovoked status if VTE; valve type/location if mechanical; stent date and DAPT status if post-PCI].

Summary: Thrombotic risk over brief interruption: [low / moderate / high].

Relevant Labs: [INR, Creatinine/CrCl, Platelet count, other pertinent values with dates] (Include only values relevant to anticoagulant management.)

Action Required to Finalize: [Missing critical inputs: last dose time, renal function, anesthesia type, procedural bleeding risk] (Include only if critical data are missing; otherwise omit.)

Medication Management Plan

(Document each antithrombotic agent in use. Omit agents not applicable.)

[Drug name]

• Regimen and Indication: [Dose/route/frequency]; [Indication].
• Last confirmed dose: [MM/DD/YYYY HH:MM]; Source: [Patient report / MAR / Pharmacy record].
• Pre-op plan: [Continue / Hold for # hours/days]—[Rationale tied to renal function, half-life, and bleeding risk]. [Target pre-op INR if warfarin].
• Bridging: [Not indicated / Agent, dose, last pre-op dose timing, post-op restart criteria]. (Include only if bridging is used.)
• Post-op restart: [Earliest MM/DD/YYYY HH:MM (POD#)]; [Prophylactic then escalate to therapeutic / Full dose]; [Conditions for restart].
• Monitoring: [INR/anti-Xa/aPTT schedule and targets as applicable].

Neuraxial/Regional Anesthesia Constraints

(Include only if neuraxial/regional is planned or possible; otherwise omit.)

• Placement timing: [Minimum interval from last dose to needle/catheter placement by agent].
• Catheter removal timing: [Minimum interval from last dose to removal].
• Post-removal restart: [Minimum interval after removal before anticoagulant restart].
• Revalidation: Plan must be revalidated if anesthesia approach changes.

Hemostatic Disorders and Support

(Include only if patient has a bleeding disorder requiring perioperative support; otherwise omit.)

• Diagnosis: [VWD type / Hemophilia type and severity / Thrombocytopenia etiology / Other].
• Targets: [Pre-op and post-op factor/activity/platelet targets].
• Products/Agents: [Product name, dose, timing; antifibrinolytics; DDAVP; platelets/cryoprecipitate as applicable].
• Monitoring: [Assays, timing, thresholds for redosing].

Communication & Contingencies

• Proceduralist informed: [MM/DD/YYYY]; [Method]; [Name].
• Anesthesia informed: [MM/DD/YYYY]; [Method]; [Name].
• Patient informed: [MM/DD/YYYY]; [Method].
• Other services: [Pharmacy/Nursing/Anticoagulation clinic as applicable]; [Date]; [Method].
• Owner of updates: [Service/Name].

Contingencies:

• If procedure rescheduled: [Elements requiring recalculation]; [Who recalculates and communicates].
• If urgent/emergent surgery: [Contact: Service/Name/Pager]; [Reversal framework if applicable].
• If post-op bleeding: [Contact Service/Name]; [Hold parameters].

Documentation Integrity: Last-dose timing verified by [Source] on [MM/DD/YYYY]. This plan is conditional on the procedure date/time and anesthesia approach documented above; revalidate if these change.