Procedure-specific bleeding risk assessment: a multidisciplinary expert consensus companion to the 2026 periprocedural anticoagulant management guidelines

Periprocedural anticoagulant management requires balancing thrombotic risk against procedure-specific bleeding risk. Existing procedure bleeding risk classifications are fragmented across specialties, inconsistent in methodology, and rarely extend beyond a few procedural domains, limiting their clinical applicability.

To develop a comprehensive, standardized, procedure-specific bleeding risk classification to accompany the 2026 GIHP-SFAR periprocedural anticoagulant management guidelines.

A formal multidisciplinary consensus was conducted under the auspices of GIHP and SFAR, in collaboration with 24 surgical and interventional specialty societies. For each procedural domain, a working group performed a systematic literature review. Procedures were classified into four tiers: no bleeding risk, low bleeding risk, high bleeding risk, and very high bleeding risk. A specific category was created for procedures carrying particular contextual risk (e.g., anatomical site, patient factors, or need for reversible anticoagulation). Consensus was reached by the full expert panel.

Twenty-four procedural domains were classified, ranging from regional anaesthesia and digestive endoscopy to cardiac surgery, neurosurgery, and ophthalmology. Each domain provides a procedure-specific bleeding risk table, with narrative supporting evidence. Procedures warranting delayed resumption of anticoagulation (≥72 hours) or use of short-acting/reversible anticoagulants are identified. The classification covers common and complex surgical scenarios, including those with limited published evidence where structured expert opinion was applied.

This companion document provides clinicians with a standardized, evidence-based, procedure-specific bleeding risk framework across 24 domains to support individualized periprocedural anticoagulant decisions in daily practice.