2026 Southeastern Residency Conference

Authors: Madison Farkas and Gregg Knowles

Background: Periprocedural management of chronic anticoagulation is an important consideration for patients undergoing invasive cardiovascular procedures such as cardiac catheterization. Anticoagulant therapy is often temporarily held to reduce procedural bleeding risk; however, delayed or missed resumption after the procedure may increase the risk of thromboembolic complications. Current evidence, including the 2022 CHEST Guideline and Expert Panel Report: Perioperative Management of Antithrombotic Therapy and findings from the PAUSE trial, supports standardized, time-based strategies for interruption and resumption of anticoagulants to balance bleeding and thrombotic risks. Despite these recommendations, variability in real-world practice and inconsistent documentation of post-procedure anticoagulant management may result in unnecessary therapy interruptions and increased patient safety risks. The purpose of this research is to determine the frequency of delayed resumption of anticoagulation in post cardiac catheterization patients and evaluate the impact of a pharmacy-driven intervention on addressing gaps in care

Methods: This single-center, pre-post implementation study evaluated periprocedural anticoagulation management in patients undergoing cardiac catheterization at a large community hospital. An electronic daily report was developed to identify patients who may require resumption of chronic anticoagulation following cardiac catheterization. The report populates based on the following criteria: (1) presence of post–cardiac catheterization orders, (2) documentation of an anticoagulant on the patient’s home medication list, and (3) absence of an active inpatient anticoagulant medication order. The report is reviewed daily by the investigator to identify patients whose chronic anticoagulation may have been held for the procedure but not yet resumed. For patients meeting these criteria, the medical record is reviewed to assess procedural details, bleeding risk, and clinical appropriateness for anticoagulation resumption. If anticoagulation appears appropriate and has not been restarted within 48 hours of the cardiac catheterization, the investigator communicates with the responsible clinical team to recommend therapy resumption when clinically indicated. The primary endpoint of this study is Proportion of patients without appropriate resumption of anticoagulation post cardiac catheterization. The secondary endpoint is the Proportion of patients with anticoagulation resumed following pharmacist intervention.

Results: Delayed resumption of home anticoagulation within 48 hours of cardiac catheterization occurred in 38% (25/66) of patients in the pre-implementation group and 45% (22/49) of patients in the post-implementation group. Among patients in whom anticoagulation was not resumed, inappropriate holds were identified in 9% (6/66) pre-implementation and 12% (6/49) post-implementation. In the post-implementation group, pharmacy intervened in 5 of 6 cases of inappropriately held anticoagulation (1 patient was lost to follow-up). Of these, 4 interventions were accepted, resulting in resumption of therapy. Common reasons for inappropriate holds included omission from the home medication list and delayed recognition prior to pharmacist intervention. Overall, pharmacy intervened to request anticoagulation resumption in 10% (5/49) of patients. The mean number of patients identified on the daily anticoagulation surveillance report was 0.84 (SD 0.87).

Conclusion: Delayed anticoagulation resumption occurred more frequently than originally reported which emphasized the need for process improvement. Pharmacy involvement via the daily surveillance report played a key role in ensuring appropriate and timely resumption when clinically indicated.