About the Perioperative Anticoagulant Management Tool

A conservative, traceable, neuraxial-aware planner that surfaces stop/restart timing, renal considerations, and clear source citations for peri-procedure anticoagulation.

What the tool does

Accepts key inputs (anticoagulant; age, sex, SCr, height, weight with Cockcroft–Gault method; procedure category; thrombotic risk; neuraxial catheter status; scheduled date and time).
Produces a clear plan: stop and restart windows with absolute timestamps when a date is provided; CrCl method and value; warnings including neuraxial hard stops; bridging governance; and a “Source” line to the exact appendix/page used.
Defaults to conservative timing. If uncertainty exists, it warns and recommends specialist input.

Clinical provenance & sources

Implements: MD Anderson Peri-Procedure Anticoagulants, Version 8 (approved 07/15/2025).

DOACs: Table 3 (p.10) and Appendix I (pp.29–31)
Warfarin: Appendix J (p.32)
LMWH/UFH: Appendix D (pp.13–14) and Appendix H (pp.26–28)

Neuraxial catheter timing when not explicit in MDACC: institutional summaries derived from ASRA (e.g., Stanford). The tool cites “ASRA/Stanford institutional guidance” alongside MDACC in catheter logic.

We do not invent new clinical rules. Where MDACC or ASRA-derived summaries are silent, the tool presents a conservative warning and advises consultation with Hematology/Anesthesia.

Safety, scope & limitations

This tool supports, not replaces, clinical judgment. Always confirm local policy and current ASRA guidance for neuraxial catheters. Do not enter patient identifiers. The calculator is for planning logic, not patient data storage. Use is at the clinician’s discretion, contingent on secure hemostasis and individual patient factors.

Independence notice: This is an independent project that is not affiliated with, sponsored by, or endorsed by MD Anderson Cancer Center. It implements their published guidance for clarity and ease of use and cites the relevant tables/appendices so users can verify each step.

How calculations are determined (traceability summary)

DOACs

Apixaban, rivaroxaban, edoxaban, dabigatran: hold/restart intervals follow MDACC tables/appendices with renal-tier handling (especially for dabigatran) and neuraxial hard stops. No DOAC dosing while a neuraxial catheter is in place; restart on the later of baseline timing or catheter-removal gap per ASRA/Stanford guidance. Governance: Do not bridge DOACs. Very-high risk adds Appendix I p.31 advisory; no auto-bridging schedule.

Warfarin

Standard 5-day pre-procedure hold; restart windows by bleeding risk. INR governance: check INR pre-procedure; target <1.5; correct or delay if ≥1.5 within 24–48 h. Bridging appears only for high/very-high thrombosis risk and respects renal function (UFH preference if CrCl <30).

LMWH/UFH

Pre-procedure stops and post-procedure restarts per MDACC. Neuraxial catheter gating applies: no dosing while a catheter is in place; restart on the later of baseline timing or removal gap; verify aPTT normalization for UFH.

Recent updates in v8.0-r5 (2025-09-01)

Neuraxial-aware flow with catheter gating across DOACs, LMWH, and UFH.
Warfarin governance line always shown (INR target and correction window).
DOAC “no bridging” by default with Appendix I p.31 exception advisory for very-high risk.
IR and Neurosurgery tabs populated from curated procedure lists with synchronized bleeding-risk mapping.
Cockcroft–Gault chooser (ABW/IBW/AdjBW) with optional minimum SCr 0.6 mg/dL (53 µmol/L) soft warning.

Credits & contact

Project owner & development: Dr. Máté Majtán

Special thanks: Dr. Bassam Ali (Békés County Central Hospital, Gyula) for clinical review

Questions, bug reports, or requests: please use the Feedback page.

Privacy & data

The calculator runs client-side and does not store patient identifiers. We may use aggregate, privacy-friendly analytics (e.g., page views) to guide improvements—no PHI is collected. If you submit feedback with contact details, we will use it only to respond to your message or improve the tool.

FAQ

Who is this for?

Clinicians and perioperative teams who need a quick, conservative timing plan informed by MDACC V8 and neuraxial safety notes.

Does this store data?

No patient data is stored by the calculator. Feedback submissions are optional and should contain no PHI.

Is this medical advice?

No. It supports—not replaces—clinical judgment. Always confirm local policy and ASRA guidance.

How do I report a discrepancy?

Use the Feedback page and include the drug, CrCl context, procedure category, and what looked off. Do not include identifiers.

Can I use it offline?

Once loaded, most logic runs offline. However, always check the live site for the latest version before relying on a plan.

Open the Calculator Send Feedback