Pre-procedure IR Guidelines - Anticoag
| ANTICOAGULATION | |||||
| drug to look up: | |||||
| recommendation: | Half-life | Low risk | |||
| Alphabetical List | |||||
| Half-life | Low risk | High risk | Re-Initiation | max plt inhibition | |
| Apixaban | 12 hours | Do not withhold | GFR > 50 = 4 doses. GFR < 50 = 6 doses. Consider anti-Xa activity or apixaban level with impaired renal function. If stat or emergent = consider reversal agent (Andexanet Alfa) |
24 hours | |
| eliquis | 12 hours | Do not withhold | GFR > 50 = 4 doses. GFR < 50 = 6 doses. Consider anti-Xa activity or apixaban level with impaired renal function. If stat or emergent = consider reversal agent (Andexanet Alfa) |
24 hours | |
| Aspirin | 3 – 10 hours |
Do not withhold | 3 – 5 days | 24 hours | |
| Betrixaban | 37 hours | Do not withhold | 3 doses Consider anti-Xa activity with impaired renal function. If stat or emergent = consider reversal agent (Andexanet Alfa) |
24 hours | |
| Bevyxxa | 37 hours | Do not withhold | 3 doses Consider anti-Xa activity with impaired renal function. If stat or emergent = consider reversal agent (Andexanet Alfa) |
24 hours | |
| Edoxaban | 9 – 11 hours |
Do not withhold | 2 doses Consider Anti-Xa Activity with impaired renal function. If stat or emergent = consider reversal agent (Andexanet Alfa) |
24 hours | |
| Savasya | 9 – 11 hours |
Do not withhold | 2 doses Consider Anti-Xa Activity with impaired renal function. If stat or emergent = consider reversal agent (Andexanet Alfa) |
24 hours | |
| Lixiana | 9 – 11 hours |
Do not withhold | 2 doses Consider Anti-Xa Activity with impaired renal function. If stat or emergent = consider reversal agent (Andexanet Alfa) |
24 hours | |
| Rivaroxaban | 7 – 11 hours |
Do not withhold | GFR > 30 = 2 doses. GFR < 30 = 3 doses. Consider Anti-Xa Activity or Rivaroxaban Level with impaired renal function. If stat or emergent = consider reversal agent (Andexanet Alfa) |
24 hours | |
| Xarelto | 7 – 11 hours |
Do not withhold | GFR > 30 = 2 doses. GFR < 30 = 3 doses. Consider Anti-Xa Activity or Rivaroxaban Level with impaired renal function. If stat or emergent = consider reversal agent (Andexanet Alfa) |
24 hours | |
| Warfarin (Coumadin) | 40 hours | Target INR ≤ 3.0 Consider bridging for high thrombosis risk cases |
5 days until INR ≤ 1.8 Consider bridging for high thrombosis risk cases If stat or emergent = consider reversal agent |
Low risk: not applicable; if bridging, same day reinitiation High risk: 24 hours |
|
| Aspirin / Dipyridamole (Aggrenox) | 13 hours | ||||
| Cangrelor (Kengreal) | 3 – 4 minutes |
Defer procedure until off medication. If STAT or emergent = 1 hour. Multidisciplinary discussion with primary team and cardiology suggested. |
Patients on cangrelor are peri-procedural period from cardiac intervention; multidisciplinary and shared decision making suggested. | 95-100% | |
| Clopidogrel (Plavix) | 6 hours | Do not withhold | 5 days | Loading dose (≥ 300 mg): 24 hours Non-Loading dose (75 mg): 6 hours | 50-60% |
| Prasugrel (Effient) | 2 – 15 hours |
Do not withhold | 7 days | 24 hours | 80% |
| Ticagrelor (Brilinta) | 7 hours | Do not withhold | 5 days | 24 hours | 85-90% |
| Ticlopidine (Ticlid)* | 13 hours | Do not withhold | 7 days | 24 hours | |
| Cilostazol (Pletal) | 11 – 13 hours |
Do not withhold | Not applicable | ||
| Heparin | 1.5 hours | Do not withhold | Therapeutic dosing: 4 – 6 hours and check aPTT or anti-Xa level Prophylactic dosing: 6 hours after last dose |
6 – 8 hours | |
| Dalteparin (Fragmin) | 2 – 5 hours |
Do not withhold | 12 hours | 12 hours | |
| Enixaprin (Lovenox) | 4.5 – 7 hours |
Do not withhold | Prophylactic dosing: 1 dose Therapeutic dosing: 2 doses or 24 hours |
12 hours | |
| Fondaparinux (Arixtra) | 17 hours | Do not withhold | GFR > 50 = 2 – 3 days GFR < 50 = 3 – 5 days |
24 hours | |
| Argatroban (Acova / Novastan) | 0.75 hours | Do not withhold | 2 – 4 hours and check aPTT | 4 – 6 hours | |
| Bivalirudin (Angiomax) | 0.5 hours | Do not withhold | 2 – 4 hours and check aPTT | 4 – 6 hours | |
| Dabigatran (Pradaxa) | 14 hours | Do not withhold | GFR > 50 = 4 doses. GFR < 50 = 6 – 8 doses. Consider thrombin time or dabigatran level with impaired renal function. If stat or emergent = consider reversal agent (Idarucizumab) |
24 hours | |
| Diclofenac (Voltaren / Cambia) | 2 – 6 hours | do not withhold | No recommendation | No recommendation | |
| Ibuprofen (Advil / Motrin) | 2-4 hr | do not withhold | No recommendation | No recommendation | |
| Ketoprofen | do not withhold | No recommendation | No recommendation | ||
| Indomethacin (Indocin) | 5 – 7 hours | do not withhold | No recommendation | No recommendation | |
| Ketorolac (Toradol) | 5-6 hr | do not withhold | No recommendation | No recommendation | |
| Celecoxib (Celebrex) | 7 – 15 hours | do not withhold | No recommendation | No recommendation | |
| Diflunisal | do not withhold | No recommendation | No recommendation | ||
| Naproxen (Naprosyn) | 17-Dec | do not withhold | No recommendation | No recommendation | |
| Sulindac (Cinoril) | do not withhold | No recommendation | No recommendation | ||
| Meloxicam (Mobic) | 15-20 | do not withhold | No recommendation | No recommendation | |
| Nabumetone (Relafen) | 22-30 | do not withhold | No recommendation | No recommendation | |
| Piroxicam (Feldene) | 45-50 | do not withhold | No recommendation | No recommendation | |
| Abcximab (ReoPro) | 8 – 12 hours |
24 hours | peri-procedural cardiac intervention; Multidisciplinary decision making. | ||
| Eptifibatide (Integrilin) | 2.5 hours | 4 – 8 hours | peri-procedural cardiac intervention; Multidisciplinary decision making. | ||
| Tirofiban (Aggrastat) | 2 hours | peri-procedural cardiac intervention; Multidisciplinary decision making. | |||
| Etodolac | 6-8 hr | ||||
| Oxaproxin | 40-60 hr | ||||
| REFERENCES: | Narouze S, et al. Interventional Spine and Pain Procedures.., Regional Anesthesia & Pain Medicine. 2018;43(3):225-262. | ||||