Table 3 Suggested perioperative... | American Society of Hematology

Table 3

Suggested perioperative anticoagulation management in patients who receive heparin bridging

Patient group	Preoperative management	Postoperative management
Low-bleeding-risk surgery	Stop therapeutic-dose LMWH on morning (20-24 h) before surgery Omit evening dose with BID regimen Give 50% total dose with OD regimen	Resume therapeutic-dose LMWH* approximately 24 h after surgery (eg, the following day), when there is adequate hemostasis.
High-bleeding-risk surgery	Stop therapeutic-dose LMWH on morning (20-24 h) before surgery Omit evening dose with BID regimen Give 50% total dose with OD regimen	Delay resumption of therapeutic-dose LMWH for 48-72 h after surgery, when hemostasis is secured OR administer only low-dose LWMH† when hemostasis is secured or avoid the use of LMWH altogether.

Patient group	Preoperative management	Postoperative management
Low-bleeding-risk surgery	Stop therapeutic-dose LMWH on morning (20-24 h) before surgery Omit evening dose with BID regimen Give 50% total dose with OD regimen	Resume therapeutic-dose LMWH* approximately 24 h after surgery (eg, the following day), when there is adequate hemostasis.
High-bleeding-risk surgery	Stop therapeutic-dose LMWH on morning (20-24 h) before surgery Omit evening dose with BID regimen Give 50% total dose with OD regimen	Delay resumption of therapeutic-dose LMWH for 48-72 h after surgery, when hemostasis is secured OR administer only low-dose LWMH† when hemostasis is secured or avoid the use of LMWH altogether.

LMWH indicates low-molecular-weight heparin; BID, twice daily; and OD, once daily.

Therapeutic-dose regimen refers to a weight-adjusted regimen, for example, enoxaparin 1 mg/kg BID or dalteparin 100 IU/kg BID.

Low-dose regimen refers to a fixed-dose (not weight-adjusted) regimen, for example, enoxaparin 40 mg OD or dalteparin 5000 IU OD.