Dr. AR - Perioperative Anticoagulation Protocol - Consult Letter

OVERALL_INSTRUCTIONS

Chief Complaint

Perioperative management of anticoagulation for a patient on a direct oral anticoagulant (DOAC) scheduled for a procedure.

Template

Dear Dr. [Referring Physician], [PATIENT TITLE] [Patient LAST Name] was referred to the Thrombosis Clinic for perioperative management of anticoagulation. HISTORY OF PRESENTING ILLNESS: I have the pleasure of assessing [patient title] [Patient Last Name], a [Age]-year-old [Gender] with history of [Insert Relevant Medical History] who is scheduled to undergo [colonoscopy | cystoscopy | TURP | hernia repair | cardiac surgery | or any other procedure] on [date of procedure]. Patient has been referred to the Thrombosis Clinic at St. Paul's Hospital for periprocedural management of anticoagulation in anticipation of the procedure. CHADS2 score: [Insert CHADS2 Score (number from 0 to 6)] For: [choose one or more as relevant -CHF/ HTN/ Age/ DM/ Stroke/ TIA/ Systemic Embolism] Patient denies any history of bleeding with their anticoagulant. They have not experienced any thrombotic events in the past 12 months. They have tolerated their anticoagulation well. There are no side effects. TYPE OF PROCEDURE: [Insert Procedure Name, choose from one of the following or insert as appropriate. Bronchoscopy/ Colonoscopy/ Hernia Repair/ Cytoscopy/ TURP/ CT guided epidural injection] PROCEDURE SITE: [Choose from one of the following - St. Paul's Hospital/ Mt. St. Joseph hospital/ Lion's gate Hospital/ Richmond Hospital/ Vancouver General Hospital/ UBC Hospital] ENDOSCOPIST / SURGEON: [Referring Physician] INDICATION FOR ANTICOAGULATION: [choose from one of the following (Atrial fibrillation/ Mechanical Heart Valve/ Venous Thromboemoblism/ Arterial Thrombosis/ Insert appropriate reason)] PAST MEDICAL HISTORY: [Insert Past Medical History] MEDICATIONS: [Medication List] ALLERGIES: [Allergy (ST)] PHYSICAL EXAMINATION: Deferred due to the telehealth nature of this consultation. LABORATORY RESULTS: [EXT Labs Categorized Last 30 day-All Enc] PLAN: The patient was provided with the following recommendation. [Insert Date of procedure - 5] 5 days before Procedure ----- [Insert Medication and Dosage] [Insert Date of procedure - 4] 4 days before Procedure ----- [Insert Medication and Dosage] [Insert Date of procedure - 3] 3 days before Procedure ----- [Insert Medication and Dosage] [Insert Date of procedure -2] 2 days before Procedure ----- **Stop** [Insert Date of procedure -1 ] 1 day before Procedure ----- **Stop** [Insert Date] Day of Procedure ----- **Stop** [Insert Date of procedure +1 ] 1 day after Procedure ----- Resume [Insert Medication and Dosage] if [Insert Condition] [Insert Date of procedure +2 ] 2 days after Procedure ----- [Insert Medication and Dosage] [Insert Date of procedure +3] 3 days after Procedure ----- [Insert Medication and Dosage] [Insert Date of procedure +4] 4 days after Procedure ----- [Insert Medication and Dosage] [Insert Date of procedure +5] 5 days after Procedure ----- [Insert Medication and Dosage] The protocol was also sent to the referring physician and patient’s family physician. The patient was informed that discontinuation of anticoagulation therapy prior to the scheduled procedure/surgery is necessary. The small but significant risk of stroke/TIA were discussed. Signs and symptoms of stroke were reviewed with the patient, who was advised to seek immediate medical attention if any such symptoms occur. FOLLOW-UP PLAN: [Choose from the following: The patient is discharged from the Thrombosis Clinic/ In person assessment at the Thrombosis Clinic within one week after the procedure. The appointment date was given to the patient today/ Telehealth assessment within one week of the procedure. Follow up date was provided to the patient today/ Please page the thrombosis consult service if you have any questions regarding the post op anticoagulation management while the patient is admitted/ Please call the Thrombosis Inpatient Consult Service on postoperative day 1/ Include any other relevant follow up plan discussed] PLEASE CONTACT US IF THE PROCEDURE DATE IS CHANGED Thank you for involving me in their care. Please feel free to contact me if you have any questions or concerns. Sincerely, Anna Rahmani MD PhD FRCPC Co-Director Thrombosis Clinic St. Paul's Hospital Clinic phone: 604-806-9455 Clinic Fax: 604-602-8652