MAPPP1.3.12

Despite the considerable efficacy of antithrombotics and the increased number of oral anticoagulants now available, preventable bleeding and thrombotic events are still unacceptably common. While recently marketed agents require less laboratory monitoring, problems with the clinical management of anticoagulated patients persist, particularly in the peri-procedural period.

Surgery and invasive medical interventions increase the risk of bleeding, while withholding anticoagulants increases the risk of thrombosis due to the underlying condition(s) for which anticoagulation was originally prescribed. The clinical team must therefore balance these competing risks and make educated decisions regarding the decision to interrupt oral anticoagulation for a medical procedure and, if interrupted, whether to "bridge" anticoagulation with injectable anticoagulants, such as low molecular weight heparin (LMWH) in warfarin treated patients.

This guide is intended to:
-Assist clinicians in the simultaneous evaluation of procedure-related bleeding risk and underlying risk of thrombosis
-Guide decisions regarding the interruption of anticoagulation and the use of anticoagulant "bridging"
-Provide detailed guidance for drug dosing and laboratory monitoring in the peri-procedural period
-Encourage clear communication between clinicians involved in prescribing anticoagulants and performing invasive procedures

This material was created by the multidisciplinary members of the Peri-Procedural Task Force of the New York State Anticoagulation Coalition and IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 10SOW-NY-AIM-7.3-14-01

Version History Fixed an issue with the icon on iPads. 1.3.12 Mar 13 Minor bug fixes 1.3.11 10/30/2025 This release updates the app to latest frameworks and plugins. 1.3.10 09/20/2025 Fixed some minor copy issues. 1.3.01 05/06/2025 Updated copy for all drugs and added references. 1.3.0 04/01/2025 Updated copy for the following:
High Bleeding Risk Procedures Table
Bleeding Risk footnotes
High/Moderate/Low Thromboembolic Risk Tables
Anti-platelet results
Added new references
Updated target iOS build version 1.2.84 01/07/2025 Updated copy changes. 1.2.83 09/18/2024 -minor fixes 1.2.71 06/22/2023 -Updates to text content. 1.2.6 06/07/2023 Reference to application feature in Perioperative Management of the Antithrombotic Therapy, CHEST Guideline. Volume 162, Issue 5, E207-E243, November 1, 2022
Verbiage updates. 1.2.5 01/04/2023 Reference to application feature in Perioperative Management of the Antithrombotic Therapy, CHEST Guideline. Volume 162, Issue 5, E207-E243, November 1, 2022
Verbiage updates. 1.2.4 12/28/2022 Reference to application feature in Perioperative Management of the Antithrombotic Therapy, CHEST Guideline. Volume 162, Issue 5, E207-E243, November 1, 2022
Verbiage updates. 1.2.3 12/27/2022 Updated App Icons
Updated to include asking permission for app tracking
Various tweaks and minor updates 1.2.2 07/21/2021 Performance updates and improvements. 1.2.1 10/01/2020 Fixed superscript typos to be subscript 1.1.6 01/03/2020 Clinical updates to text and wording 1.1.5 12/10/2019 - Miscellaneous formatting updates to HTML
- Minor content updates/fixes
- Added a new footnote for Warfarin 1.1.4 12/08/2017 Made the More information button bigger for better touch controls
Updated some minor text to be aligned with other text 1.1.2 04/20/2017 Updated disclaimer text 1.1.1 06/21/2016 Added features:
- added a back button
- moved the info button down
- added the ability to swipe
- fixed various bugs 1.1.0 04/29/2016 Updated Reference:

"Spyropoulos AC, Al-Badri A, Sherwood MW, Douketis JD. Periprocedural management of patients on a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery. J Thromb Haemost. 2016 Mar 14. doi: 10.1111/jth.13305. [Epub ahead of print]" 1.0.1 03/31/2016 1.0 03/18/2016