cliot (version 1.0.0)

perioperative_anticoagulation_pause: Perioperative Anticoagulation Use for Surgery Evaluation (PAUSE)

Description

Provides standardized perioperative management recommendations for patients with Atrial Fibrillation (AF) who are taking a Direct Oral Anticoagulant (DOAC) and require an elective surgery or procedure. The logic follows the PAUSE study protocol to minimize bleeding risk while preventing thromboembolism without heparin bridging.

Usage

perioperative_anticoagulation_pause(drug_name, procedure_bleeding_risk, crcl_ml_min)

Value

A list containing:

PreOp_Recommendation

Instruction on how many days prior to surgery to stop the medication.

Last_Dose_Timing

Specific guidance on when the final pre-operative dose should be taken.

PostOp_Resumption

Guidance on when to restart the medication based on bleeding risk.

Arguments

drug_name

String. The DOAC being used. Options: "apixaban", "rivaroxaban", "edoxaban", "dabigatran".

procedure_bleeding_risk

String. The bleeding risk associated with the planned procedure. Options: "low", "high".

crcl_ml_min

Numeric. Creatinine Clearance in mL/min. Used specifically to adjust interruption windows for Dabigatran or check validity for Xa inhibitors.

References

Douketis JD, Spyropoulos AC, Duncan J, et al. Perioperative Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant. JAMA Intern Med. 2019;179(11):1469-1478. doi:10.1001/jamainternmed.2019.2431

Examples

# Example 1: Apixaban, Low Risk Procedure
perioperative_anticoagulation_pause("apixaban", "low", 60)

# Example 2: Dabigatran, High Risk Procedure, Renal Impairment (CrCl 40)
perioperative_anticoagulation_pause("dabigatran", "high", 40)