Perioperative Management of Antiplatelet and Anticoagulant Therapy in Patients Undergoing Interventional Techniques: 2024 Updated Guidelines from the American Society of Interventional Pain Physicians (ASIPP)

• Published in: Pain physician 2024-08, Vol.27 (S6), p.S1
• Main Authors: Manchikanti, Laxmaiah, Sanapati, Mahendra R, Nampiaparampil, Devi, Schneider, Byron J, Bautista, Alexander, Kaye, Alan D, Knezevic, Nebojsa Nick, Abd-Elsayed, Alaa, Navani, Annu, Christo, Paul J, Helm Ii, Standiford, Kaye, Adam M, Karri, Jay, Pampati, Vidyasagar, Gupta, Sanjeeva, Manocha, Vivekanand A, Soin, Amol, Gupta, Mayank, Bakshi, Sanjay, Gharibo, Christopher G, Candido, Kenneth D, Bux, Anjum, Vinayakan, Anilkumar, Belamkar, Vinayak, Stayner, Scott, Atluri, Sairam, Nashi, Sara E, Applewhite, Megan K, Flanagan, Chelsi, Rakhamimova, Emiliya, Limerick, Gerard, Patel, Kunj G, Willeford, Sierra, Hirsch, Joshua A
• Format: Article
• Language: English
• Subjects: Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Chronic Pain - drug therapy; Hemorrhage - chemically induced; Humans; Pain Management - methods; Pain Management - standards; Perioperative Care - methods; Perioperative Care - standards; Platelet Aggregation Inhibitors - therapeutic use; Societies, Medical - standards
• ISSN: 2150-1149; 2150-1149

The frequency of performance of interventional techniques in chronic pain patients receiving anticoagulant and antiplatelet therapy continues to increase. Understanding the importance of continuing chronic anticoagulant therapy, the need for interventional techniques, and determining the duration and discontinuation or temporary suspension of anticoagulation is crucial to avoiding devastating complications, primarily when neuraxial procedures are performed. Anticoagulants and antiplatelets target the clotting system, increasing the bleeding risk. However, discontinuation of anticoagulant or antiplatelet drugs exposes patients to thrombosis risk, which can lead to significant morbidity and mortality, especially in those with coronary artery or cerebrovascular disease. These guidelines summarize the current peer reviewed literature and develop consensus-based guidelines based on the best evidence synthesis for patients receiving anticoagulant and antiplatelet therapy during interventional procedures. Review of the literature and development of guidelines based on best evidence synthesis. To provide a current and concise appraisal of the literature regarding the assessment of bleeding and thrombosis risk during interventional techniques for patients taking anticoagulant and/or antiplatelet medications. Development of consensus guidelines based on best evidence synthesis included review of the literature on bleeding risks during interventional pain procedures, practice patterns, and perioperative management of anticoagulant and antiplatelet therapy. A multidisciplinary panel of experts developed methodology, risk stratification based on best evidence synthesis, and management of anticoagulant and antiplatelet therapy. It also included risk of cessation of anticoagulant and antiplatelet therapy based on a multitude of factors. Multiple data sources on bleeding risk, practice patterns, risk of thrombosis, and perioperative management of anticoagulant and antiplatelet therapy were identified. The relevant literature was identified through searches of multiple databases from 1966 through 2023. In the development of consensus statements and guidelines, we used a modified Delphi technique, which has been described to minimize bias related to group interactions. Panelists without a primary conflict of interest voted on approving specific guideline statements. Each panelist could suggest edits to the guideline statement wording and could suggest additional qualifying