Table 12.

Classification of elective surgical interventions according to bleeding risk

Minor risk interventions (i.e. infrequent bleeding and with low clinical impact)

Dental extractions (1–3 teeth), paradontal surgery, implant positioning, subgingival scalling/cleaning

Cataract or glaucoma intervention

Endoscopy without biopsy or resection

Superficial surgery (e.g. abscess incision; small dermatologic excisions, skin biopsy)

Pacemaker or ICD implantation (except complex procedures)

Electrophysiological study or catheter ablation (except complex procedures)

Routine elective coronary/peripheral artery intervention (except complex procedures)

Intramuscular injection (e.g. vaccination)

Low-risk interventions (i.e. infrequent bleeding or with non-severe clinical impact)

Complex dental procedures

Endoscopy with simple biopsy

Small orthopaedic surgery (foot, hand, arthroscopy, …)

High-risk interventions (i.e. frequent bleeding and/or with important clinical impact)

Cardiac surgery

Peripheral arterial revascularization surgery (e.g. aortic aneurysm repair, vascular bypass)

Complex invasive cardiological interventions, including lead extraction, (epicardial) VT ablation, chronic total occlusion PCI etc.

Neurosurgery

Spinal or epidural anaesthesia; lumbar diagnostic puncture

Complex endoscopy (e.g. multiple/large polypectomy, ERCP with sphincterotomy etc.)

Abdominal surgery (incl. liver biopsy)

Thoracic surgery

Major urologic surgery/biopsy (incl. kidney)

Extracorporeal shockwave lithotripsy

Major orthopaedic surgery

For each patient, individual factors relating to bleeding and thromboembolic risk need to be taken into account and be discussed with the operating physician and the patient (see Figure 13).