Procedure-related factors affecting bleeding risk

Procedure-related bleeding risk can be classified asDouketis, 2022Halvorsen, 2022:

• minimal risk—procedures with no clinically relevant risk of major bleeding (eg minor dental extractions, skin excisions of less than 1 cm, cataract procedures)
• low to moderate risk—procedures with a possibility of major bleeding, but an overall lower incidence (eg laparoscopic cholecystectomy)
• high risk—procedures with a higher incidence of major bleeding, which include procedures that are invasive (eg bowel resection, major orthopaedic surgery) or involve highly vascular organs (eg kidney, liver, spleen), as well as procedures with a low incidence of bleeding but for which a minor bleed can cause significant morbidity or mortality (eg intracranial, spinal or cardiac surgery).

Interruption of antithrombotic therapy is usually not needed if the procedure is considered to have a minimal risk of major bleeding.

A suggested risk stratification of the bleeding risk of individual procedures is suggested in Table 2 of the American College of Chest Physicians Perioperative Management of Antithrombotic Therapy guidelines.