Bridging Anticoagulation Practices

Study Questions:

What is the process used by cardiologists, internists, gastroenterologists, and orthopedic surgeons to currently manage patients who receive oral anticoagulation (AC) and undergo surgery or an invasive procedure?

Methods:

The survey was completed by 945 physicians involved in the periprocedural management of AC. The results provide a template for educational and research projects geared toward the development of clinical pathways and point-of-care tools to improve this area of health care.

Results:

More than three of four survey respondents believed that a standardized process or protocol is either extremely or very important for the periprocedural management of AC. However, 70% of respondents said that a standardized protocol for guidance of periprocedural management of AC is not available in their practice, and an additional 13% were not aware of whether a protocol was in place.

Conclusions:

The authors concluded that bridging AC is a complicated undertaking and involves a number of health care providers, including physicians who perform procedures, the primary care physician, nurses, and pharmacists.

Perspective:

This study reports that the periprocedural management of patients who receive AC and who undergo surgery or invasive procedures involves a number of health care providers, including physicians who perform procedures, the primary care physician, nurses, and pharmacists. Given this complex clinical scenario involving multiple health care professionals, it makes sense to develop clinical pathways with standardized institutional protocols. Furthermore, this represents an important opportunity for professional societies and guidelines committees to work together to provide meaningful suggestions on the basis of current data. In addition, there exists an opportunity for professional societies to support research to address unanswered clinical questions, as well as promote robust educational programs to improve AC care.

Clinical Topics: Anticoagulation Management

Keywords: Anticoagulants, Health Personnel, Nurses, Pharmacists, Physicians, Primary Care, Point-of-Care Systems, Quality Improvement, Surgeons, Surgical Procedures, Operative


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