Anticoagulation Management in CEPOD and Semi-elective Tracheostomy: A Multidisciplinary Survey

BACKGROUND: Tracheostomy is a frequently performed airway procedure in both emergency (CEPOD) and semielective settings. Within our institution, perioperative anticoagulation management varies between clinicians, highlighting the absence of a standardized local protocol and the limited availability of procedure-specific guidance in the literature. METHODS: A cross-sectional survey was conducted among ENT surgeons and anesthetists at Mater Dei Hospital to explore current approaches to anticoagulation management in CEPOD and semielective tracheostomy. Data were collected on clinician experience, procedural exposure, perceived complications, and decision-making in relation to anticoagulant and antiplatelet therapy. RESULTS: Twenty-three clinicians responded to the survey, comprising 12 anesthetists (52.2%) and 11 ENT surgeons (47.8%). Most respondents (n = 19, 82.6%) reported involvement in fewer than 10 tracheostomies annually. Bleeding was the most commonly perceived complication of open tracheostomy (n = 17, 73.9%), while false passage formation (n = 9, 39.1%) and posterior tracheal wall injury (n = 7, 30.4%) were most frequently associated with percutaneous techniques. The majority of clinicians supported cessation of both therapeutic (n = 20, 87.0%) and prophylactic (n = 18, 78.3%) anticoagulation. A target INR ≤1.5 was preferred by most respondents (n = 18, 78.3%). Practice varied considerably in relation to dual antiplatelet therapy and direct oral anticoagulants (DOACs). Notably, most clinicians (n = 20, 87.0%) were unaware of formal institutional guidelines, and an equal proportion supported the development of standardized protocols. CONCLUSION: Anticoagulation management in tracheostomy practice shows a degree of variability. The absence of formal guidance highlights an opportunity to develop evidence-based, multidisciplinary approaches that may support patient safety and procedural outcomes.