Navigating the pause-patient experiences with perioperative anticoagulation interruption: a qualitative study

Patients on chronic anticoagulation frequently undergo temporary medication interruption for surgical or invasive procedures, yet the patient perspective on this experience remains poorly characterized.

The aim of this study was to identify the concerns, preferences, and unmet needs of patients undergoing perioperative anticoagulation interruption to inform patient-centered care strategies.

A qualitative study using 7 semistructured focus groups was conducted between 2022 and 2023 at a single academic health system. Twenty-two adults on chronic oral anticoagulation who had recently undergone planned interruption for high-risk procedures were enrolled. Groups were stratified by anticoagulant type (warfarin vs direct oral anticoagulant [DOAC]). Emergent themes from focus group transcripts were identified using grounded theory with iterative open coding and consensus analysis via Dedoose software.

Nineteen themes were identified and consolidated into 5 core categories: (1) Risk Perception, reflecting fears of bleeding and clotting shaped by personal history; (2) Communication and Instruction Clarity, emphasizing the need for clear, timely guidance; (3) Self-Management and Logistical Challenges, including difficulties with injections, medication tracking, and dietary management; (4) Healthcare System Gaps, including care coordination failures and access delays; and (5) Emotional and Adaptive Responses, including stress and creative coping strategies. Bruising and injection challenges were more prominent concerns than major clinical events.

Perioperative anticoagulation interruption poses substantial informational, emotional, and logistical burdens on patients. Enhancing communication, supporting self-management, and improving system coordination are essential components of anticoagulation stewardship. Integration of patient-reported outcomes into future trials is warranted.