Publication: Perioperative Anticoagulation and Risk Assessment: Building a Bridge Over a STREAM
Date
2025
Authors
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Journal ISSN
Volume Title
Publisher
Nepal Medical Association
Abstract
Abstract
Perioperative care requires a comprehensive assessment of the risks of bleeding and thrombosis. The 2022 CHEST Guidelines offer an empirical foundation for customized treatment using clinical judgment and risk assessment based on CHA2DS2-VASC and HAS-BLED scores. Despite the ease of access to anticoagulation guidelines, decision-making remains challenging, particularly when determining the necessity of bridging therapy with unfractionated or low-molecular-weight heparin. To facilitate this decision, we provide a mnemonic, STREAM, that highlights high-risk situations that require bridging. These include recent stroke or transient ischemic attack, severe thrombophilia, rheumatic valvular disease, recent venous thromboembolism, atrial fibrillation with high CHA2DS2-VASC scores, and mechanical heart valves. This mnemonic offers physicians a methodical approach to optimize perioperative anticoagulation control while minimizing the risk of hemorrhage and thrombosis.
Description
Anil Harrison
Department of Medicine, Midwestern University, Glendale, Arizona, USA.
Sushil Rayamajhi
University of Central Florida College of Medicine/HCA Florida West Hospital, Pensacola, Florida, USA