Perioperative Anticoagulation and Risk Assessment: Building a Bridge Over a STREAM

Area of Science:

• Cardiology
• Hematology
• Anesthesiology

Background:

• Perioperative care necessitates balancing bleeding and thrombosis risks.
• Current anticoagulation guidelines, including CHA2DS2-VASC and HAS-BLED scores, aid risk assessment but decision-making for bridging therapy remains complex.
• Bridging therapy with heparin is often used but carries its own risks.

Purpose of the Study:

• To provide a simple, memorable tool for identifying patients who require bridging anticoagulation therapy during the perioperative period.
• To aid clinicians in making informed decisions regarding anticoagulation management in high-risk surgical patients.

Main Methods:

• Development of the STREAM mnemonic, which encapsulates key high-risk factors for bridging therapy.
• The mnemonic highlights specific clinical scenarios: recent stroke or transient ischemic attack, severe thrombophilia, rheumatic valvular disease, recent venous thromboembolism, atrial fibrillation with high CHA2DS2-VASC scores, and mechanical heart valves.

Main Results:

• The STREAM mnemonic offers a structured approach to perioperative anticoagulation management.
• It identifies specific high-risk conditions necessitating bridging therapy, thereby optimizing patient care.
• Facilitates a methodical decision-making process to minimize both bleeding and thrombotic events.

Conclusions:

• The STREAM mnemonic serves as a valuable tool for physicians managing perioperative anticoagulation.
• It simplifies the identification of patients requiring bridging therapy, enhancing clinical judgment and patient safety.
• Optimizes the balance between preventing thrombosis and minimizing bleeding complications in surgical patients.