Dr Aishah Soraya binti Solahudin

Moderator: Dr. Mohd Fitry Zainal Abidin

12 December 2025

Objectives:

• Understanding pharmacology and timing of common anticoagulants (VKA, DOACs, LMWH, UFH, anti-platelets)
• Identifying bleeding and thrombotic risks in non-cardiac surgery (NCS)
• Interpret perioperative management strategies : interruption, bridging, restarting
• Application of guideline-based algorithms and patient-specific considerations (renal function, thrombosis risk, bleeding risk)
• Critically appraise evidence and gaps

Summary

• Understand the pharmacology and timing of common anticoagulants
• Bleeding risk assessment must integrate patient factors and procedural risks, not only the anticoagulant pharmacology.
• Thrombotic risk stratification (CHA2DS2-VASc, VTE history, valve type) determines whether interruption is acceptable and whether bridging is justified.
• Apply guideline-based algorithms incorporating renal function, thrombosis risk, and bleeding risk
• ASRA 2025 timing recommendations are essential for safe anaesthesia in anticoagulated patients; these timings may be stricter than surgical recommendations.
• Personalised, guideline-driven perioperative strategies (ESAIC 2025, ACC/AHA 2024, ESC 2022) are the cornerstone of modern management.

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