Curbside Consults Podcast

By Robert Smyth, MD, MSc

Published February 8, 2023

In this episode of Curbside Consults, we examine the American College of Chest Physicians recent clinical practice guideline on Perioperative Management of Antithrombotic Therapy. We are joined by Dr. James Douketis, Chair in Thromboembolic Disease at McMaster University and the first author of the guideline.

00:08 – Intro
00:45 – Outline
01:16 – Reason for update
02:07 – Insider’s view
03:49 – Definitions
04:55 – Pharmacokinetics and pharmacodynamics: What’s the difference?
06:48 – Pharmacology of VKAs, DOACs, and antiplatelets
09:45 – Risk assessment of thrombus formation and bleeding
12:30 – Warfarin
15:20 – Mechanical valves
18:20 – Minor procedures
21:00 – Heparin bridging
22:30 – DOACs
25:00 – Neuraxial procedures
26:30 – Antiplatelets
29:45 – Aspirin and noncardiac surgery
32:00 – Outro

Articles discussed in this episode:

1. Douketis JD et al. Perioperative Management of Antithrombotic Therapy. Chest 2022.

The Curbside Consults series complements the foundational information in Rotation Prep by taking a deep dive into key clinical topics with expert clinicians and educators. These podcasts explore and critique the evidence behind clinical practice and break down statistical concepts for the busy clinical trainee.

James Demetrios Douketis, MD, is Staff Physician in General Internal Medicine and Clinical Thromboembolism at St. Joseph’s Healthcare Hamilton. He is a Professor of Medicine and holds the David Braley-Nancy Gordon Chair in Thromboembolic Disease at McMaster University.
Robert Smyth, MD, MSc, is a 2022–2023 NEJM Editorial Fellow. He is currently an Assistant Professor of computational biomedicine at the Boston University School of Medicine.