TH Open: Companion Journal to Thrombosis and Haemostasis · 2 authors, 2 centres
This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.
This retrospective review of 4,609 patients in a perioperative anticoagulation clinic found that 80% could potentially be managed virtually, 7% required in-person care (mainly for heparin bridging in mechanical heart valve patients), and 13% could use either model. The findings suggest that virtual care is a feasible alternative for most perioperative anticoagulant management, potentially improving access and efficiency.
**Background:** Perioperative management of anticoagulant therapy is a common clinical problem, affecting approximately 4 million patients annually in North America. Standardized protocols exist, but little attention has been paid to the delivery model. The COVID-19 pandemic accelerated the shift to virtual care, and this study explores the potential for a virtual care model in this setting.
**Methods:** This was a descriptive, retrospective medical record review of consecutive patients assessed in the perioperative anticoagulation (bridging) clinic at Hamilton General Hospital from January 1, 2016 to December 31, 2020. Data were collected on anticoagulant type (DOAC or warfarin), clinical indication for anticoagulation (atrial fibrillation/flutter [AF], mechanical heart valve [MHV], venous thromboembolism [VTE], or other), and surgery/procedure bleed risk (high, low/moderate, or minimal). Patients were classified into three groups: (1) likely safely managed virtually (low-bleed-risk surgery with anticoagulant interruption but no heparin bridging, or minimal-bleed-risk procedure with no interruption); (2) likely requiring in-person management (warfarin with MHV needing heparin bridging); and (3) manageable with either model (high-bleed-risk surgery on any anticoagulant).
**Key Results:** Over 5 years, 4,609 patients were assessed (average 922/year). The most common anticoagulant was warfarin (37%), followed by apixaban (30%) and rivaroxaban (24%); 63% were on a DOAC. The proportion of warfarin users declined over time, while DOAC use increased. Most surgeries were low/moderate bleed risk (78.6%), with 6.2% minimal and 16.2% high bleed risk. For virtual management: 79.6% (3,669) of patients were candidates (6.1% minimal bleed risk + 73.5% DOAC low/moderate bleed risk). For in-person management: 7.1% (328) of patients (warfarin with MHV needing bridging) required in-person care. For either model: 13.3% (612) of patients (DOAC high bleed risk) could use either approach.
**Clinical Implications:** A virtual care model appears feasible for the majority (80%) of perioperative anticoagulant management, potentially simplifying care, increasing accessibility for remote or mobility-limited patients, and reducing costs. Standardized, evidence-based protocols are readily available online. However, in-person care remains necessary for a small subset (e.g., those needing heparin bridging instruction). Further research is needed to confirm safety, especially in high-risk patients.