Appendix 1: Panelist Conflicts of Interest Grid

Panel Member PICO Questions Relationships *

Juan Arcelus, MD Questions related to the use of Low Molecular Weight Heparin: Funds received for CME and
In patients with a mechanical prosthetic heart valve, should bridging anticoagulation during non-CME speaking
interruption of warfarin therapy be administered vs. no bridging? (Guideline Statement 5) engagements for Sanofi
(ended in 2021). Did not
In patients with atrial fibrillation, should bridging anticoagulation be administered during draft, write, or vote on
interruption of VKA therapy vs. no bridging? (Guideline Statement 6) recommendations derived
from these PICOs.
In patients with venous thromboembolism, should bridging anticoagulation be administered
during interruption of VKA therapy vs. no bridging? (Guideline Statement 7)

In VKA-treated patients who are considered at high risk for thromboembolism, should
bridging anticoagulation be given during interruption of VKA therapy vs. no bridging?
(Guideline Statement 8)

In VKA-treated patients who are considered at low-to-moderate risk for thromboembolism,

should bridging anticoagulation be given during interruption of VKA therapy vs. no
bridging? (Guideline Statement 9)

In patients who are having a cardiac device procedure and are receiving a VKA, should VKA
be continued around the time of the procedure vs. stopping the VKA 5-6 days before the
procedure? (Guideline Statement 14)

In patients receiving VKA therapy who require VKA interruption for a colonoscopy with
anticipated polypectomy, should heparin bridging be given vs. no heparin bridging?
(Guideline Statement 15)

In patients who are receiving LWMH bridging, should the last pre-operative dose of LMWH
be given 24 hours before surgery vs. 12 hours before surgery? (Guideline Statement 18)

In patients who are receiving bridging with therapeutic-dose LMWH and are having high
bleeding-risk surgery, should therapeutic-dose LMWH be resumed within 24 hours after
 surgery vs. resuming LMWH >24 hours after surgery? (Guideline Statement 19)

In patients receiving LMWH bridging, should half the total daily dose of LMWH be given
on the day before the surgery/procedure vs. administering the full dose of LMWH?
(Guideline Statement 20)

In patients receiving LMWH bridging, should measurement of anti-factor Xa levels be

routinely done vs. no anti-factor Xa measurements? (Guideline Statement 21)

In patients who require DOAC interruption for an elective surgery/procedure, should

perioperative bridging be given vs. no bridging? (Guideline Statement 26)

In patients who require surgery within 6 weeks of placement of a bare-metal coronary stent
or within 12 months of placement of a drug-eluting coronary stent, should ASA and
clopidogrel be continued vs. stopping antiplatelet drugs 7-10 days before surgery? (Guideline
Statements 37, 38, 39, 40)

James Douketis, In patients who are receiving a DOAC (apixaban, dabigatran, edoxaban or rivaroxaban) and Received funds for
MD, FCCP require an elective surgery/procedure, should DOACs be interrupted for 1-4 days before a consultancies with Janssen,
surgery/procedure vs. interrupting DOACs earlier? (Guideline Statements 22, 23, 24, 25) Servier Canada, Bristol
Myers Squibb, and Pfizer
In patients who require DOAC interruption for an elective surgery/procedure, should (ended in 2021). Did not
perioperative bridging be given vs. no bridging? (Guideline Statement 26) draft, write, or vote on
recommendations derived
In patients who had DOAC interruption for an elective surgery/procedure, should DOACs be from these PICOs.+
resumed >24 hours after a surgery/procedure vs. resuming DOACs within 24 hours?
(Guideline Statement 27)

In patients who interrupted a DOAC before a surgery/procedure, should the anticoagulant

effect of DOACs routinely be measured with coagulation function tests vs. not measuring the
anticoagulant effect of DOACs? (Guideline Statement 28)

In patients receiving antiplatelet drugs who require non-cardiac surgery, should antiplatelet
drugs be continued perioperatively vs. stopping 7-10 days before surgery? (Guideline
 Statements 29a, 29b, 30, 31, 32, 33)

In patients receiving antiplatelet drugs who require CABG surgery, should antiplatelet drugs
be continued perioperatively vs. stopping antiplatelet drugs 7-10 days before CABG surgery?
(Guideline Statement 34, 35)

In patients who are receiving antiplatelet therapy, should platelet function assays be routinely
used to measure antiplatelet effect vs. no routine use of antiplatelet function testing?
(Guideline Statement 36)

In patients who require surgery within 6 weeks of placement of a bare-metal coronary stent
or within 12 months of placement of a drug-eluting coronary stent, should ASA and
clopidogrel be continued vs. stopping antiplatelet drugs 7-10 days before surgery? (Guideline
Statements 37, 38, 39, 40)

In patients who are receiving antiplatelet drugs and require a minor dental, dermatological or
ophthalmologic procedure, should antiplatelet drugs be continued vs stopping antiplatelet
drugs 7-10 days before the procedure? (Guideline Statements 41, 42, 43)

*No other panel members had conflicts related to the PICO questions.
+
Due to a clerical error, votes were incidentally submitted on questions pertaining to antiplatelet therapy. When this error was
discovered, the votes were removed without any impact on the final recommendations.