{"id":1581,"date":"2021-05-14T12:01:01","date_gmt":"2021-05-14T16:01:01","guid":{"rendered":"https:\/\/geiselmed.dartmouth.edu\/radiology\/?page_id=1581"},"modified":"2021-05-14T12:12:59","modified_gmt":"2021-05-14T16:12:59","slug":"anticoag","status":"publish","type":"page","link":"https:\/\/geiselmed.dartmouth.edu\/radiology\/divisions\/clinical-divisions\/interventional-radiology\/anticoag\/","title":{"rendered":"Anticoag"},"content":{"rendered":"

Pre-procedure IR Guidelines - Anticoag<\/h1>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
ANTICOAGULATION<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
drug to look up:<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
recommendation:<\/td>\nHalf-life<\/td>\nLow risk<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Alphabetical List<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
<\/td>\nHalf-life<\/td>\nLow risk<\/td>\nHigh risk<\/td>\nRe-Initiation<\/td>\nmax plt inhibition<\/td>\n<\/tr>\n
Apixaban<\/td>\n12 hours<\/td>\nDo not withhold<\/td>\nGFR > 50 = 4 doses.\u00a0 GFR < 50 = 6 doses.
\nConsider anti-Xa activity or apixaban level with impaired renal function.
\nIf stat or emergent = consider reversal agent (Andexanet Alfa)<\/td>\n		24 hours<\/td>\n<\/td>\n<\/tr>\n
eliquis<\/td>\n12 hours<\/td>\nDo not withhold<\/td>\nGFR > 50 = 4 doses.\u00a0 GFR < 50 = 6 doses.
\nConsider anti-Xa activity or apixaban level with impaired renal function.
\nIf stat or emergent = consider reversal agent (Andexanet Alfa)<\/td>\n		24 hours<\/td>\n<\/td>\n<\/tr>\n
Aspirin<\/td>\n3 \u2013 10
\nhours<\/td>\n		Do not withhold<\/td>\n3 \u2013 5 days<\/td>\n\u00a024 hours<\/td>\n<\/td>\n<\/tr>\n
Betrixaban<\/td>\n37 hours<\/td>\nDo not withhold<\/td>\n3 doses
\nConsider anti-Xa activity with impaired renal function.
\nIf stat or emergent = consider reversal agent (Andexanet Alfa)<\/td>\n		\u00a024 hours<\/td>\n<\/td>\n<\/tr>\n
Bevyxxa<\/td>\n37 hours<\/td>\nDo not withhold<\/td>\n3 doses
\nConsider anti-Xa activity with impaired renal function.
\nIf stat or emergent = consider reversal agent (Andexanet Alfa)<\/td>\n		\u00a024 hours<\/td>\n<\/td>\n<\/tr>\n
Edoxaban<\/td>\n9 \u2013 11
\nhours<\/td>\n		Do not withhold<\/td>\n2 doses
\nConsider Anti-Xa Activity with impaired renal function.
\nIf stat or emergent = consider reversal agent (Andexanet Alfa)<\/td>\n		\u00a024 hours<\/td>\n<\/td>\n<\/tr>\n
Savasya<\/td>\n9 \u2013 11
\nhours<\/td>\n		Do not withhold<\/td>\n2 doses
\nConsider Anti-Xa Activity with impaired renal function.
\nIf stat or emergent = consider reversal agent (Andexanet Alfa)<\/td>\n		\u00a024 hours<\/td>\n<\/td>\n<\/tr>\n
Lixiana<\/td>\n9 \u2013 11
\nhours<\/td>\n		Do not withhold<\/td>\n2 doses
\nConsider Anti-Xa Activity with impaired renal function.
\nIf stat or emergent = consider reversal agent (Andexanet Alfa)<\/td>\n		\u00a024 hours<\/td>\n<\/td>\n<\/tr>\n
Rivaroxaban<\/td>\n7 \u2013 11
\nhours<\/td>\n		Do not withhold<\/td>\nGFR > 30 = 2 doses. GFR < 30 = 3 doses.
\nConsider Anti-Xa Activity or Rivaroxaban Level with impaired renal function.
\nIf stat or emergent = consider reversal agent (Andexanet Alfa)<\/td>\n		\u00a024 hours<\/td>\n<\/td>\n<\/tr>\n
Xarelto<\/td>\n7 \u2013 11
\nhours<\/td>\n		Do not withhold<\/td>\nGFR > 30 = 2 doses. GFR < 30 = 3 doses.
\nConsider Anti-Xa Activity or Rivaroxaban Level with impaired renal function.
\nIf stat or emergent = consider reversal agent (Andexanet Alfa)<\/td>\n		\u00a024 hours<\/td>\n<\/td>\n<\/tr>\n
Warfarin (Coumadin)<\/td>\n40 hours<\/td>\nTarget INR \u2264 3.0
\nConsider bridging for high thrombosis risk cases<\/td>\n		5 days until INR \u2264 1.8
\nConsider bridging for high thrombosis risk cases
\nIf stat or emergent = consider reversal agent<\/td>\n		Low risk: not applicable; if bridging, same day reinitiation
\nHigh risk: 24 hours<\/td>\n		<\/td>\n<\/tr>\n
Aspirin \/ Dipyridamole (Aggrenox)<\/td>\n13 hours<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Cangrelor (Kengreal)<\/td>\n3 \u2013 4
\nminutes<\/td>\n		Defer procedure until off medication.
\nIf STAT or emergent = 1 hour.
\nMultidisciplinary discussion with primary team and cardiology suggested.<\/td>\n		Patients on cangrelor are peri-procedural period from cardiac intervention; multidisciplinary and shared decision making suggested.<\/td>\n95-100%<\/td>\n<\/tr>\n
Clopidogrel (Plavix)<\/td>\n6 hours<\/td>\nDo not withhold<\/td>\n5 days<\/td>\nLoading dose (\u2265 300 mg): 24 hours\u00a0\u00a0\u00a0 Non-Loading dose (75 mg): 6 hours<\/td>\n50-60%<\/td>\n<\/tr>\n
Prasugrel (Effient)<\/td>\n2 \u2013 15
\nhours<\/td>\n		Do not withhold<\/td>\n7 days<\/td>\n\u00a024 hours<\/td>\n80%<\/td>\n<\/tr>\n
Ticagrelor (Brilinta)<\/td>\n7 hours<\/td>\nDo not withhold<\/td>\n5 days<\/td>\n\u00a024 hours<\/td>\n85-90%<\/td>\n<\/tr>\n
Ticlopidine (Ticlid)*<\/td>\n13 hours<\/td>\nDo not withhold<\/td>\n7 days<\/td>\n\u00a024 hours<\/td>\n<\/td>\n<\/tr>\n
Cilostazol (Pletal)<\/td>\n11 \u2013 13
\nhours<\/td>\n		Do not withhold<\/td>\n<\/td>\nNot applicable<\/td>\n<\/td>\n<\/tr>\n
Heparin<\/td>\n1.5 hours<\/td>\nDo not withhold<\/td>\nTherapeutic dosing: 4 \u2013 6 hours and check aPTT or anti-Xa level
\nProphylactic dosing: 6 hours after last dose<\/td>\n		\u00a06 \u2013 8 hours<\/td>\n<\/td>\n<\/tr>\n
Dalteparin (Fragmin)<\/td>\n2 \u2013 5
\nhours<\/td>\n		Do not withhold<\/td>\n12 hours<\/td>\n\u00a012 hours<\/td>\n<\/td>\n<\/tr>\n
Enixaprin (Lovenox)<\/td>\n4.5 \u2013 7
\nhours<\/td>\n		Do not withhold<\/td>\nProphylactic dosing: 1 dose
\nTherapeutic dosing: 2 doses or 24 hours<\/td>\n		12 hours<\/td>\n<\/td>\n<\/tr>\n
Fondaparinux (Arixtra)<\/td>\n17 hours<\/td>\nDo not withhold<\/td>\nGFR > 50 = 2 \u2013 3 days
\nGFR < 50 = 3 \u2013 5 days<\/td>\n		\u00a024 hours<\/td>\n<\/td>\n<\/tr>\n
Argatroban (Acova \/ Novastan)<\/td>\n0.75 hours<\/td>\nDo not withhold<\/td>\n2 \u2013 4 hours and check aPTT<\/td>\n4 \u2013 6 hours<\/td>\n<\/td>\n<\/tr>\n
Bivalirudin (Angiomax)<\/td>\n0.5 hours<\/td>\nDo not withhold<\/td>\n2 \u2013 4 hours and check aPTT<\/td>\n4 \u2013 6 hours<\/td>\n<\/td>\n<\/tr>\n
Dabigatran (Pradaxa)<\/td>\n14 hours<\/td>\nDo not withhold<\/td>\nGFR > 50 = 4 doses.
\nGFR < 50 = 6 \u2013 8 doses.
\nConsider thrombin time or dabigatran level with impaired renal function.
\nIf stat or emergent = consider reversal agent (Idarucizumab)<\/td>\n		\u00a024 hours<\/td>\n<\/td>\n<\/tr>\n
Diclofenac (Voltaren \/ Cambia)<\/td>\n2 \u2013 6 hours<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Ibuprofen (Advil \/ Motrin)<\/td>\n2-4 hr<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Ketoprofen<\/td>\n<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Indomethacin (Indocin)<\/td>\n5 \u2013 7 hours<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Ketorolac (Toradol)<\/td>\n5-6 hr<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Celecoxib (Celebrex)<\/td>\n7 \u2013 15 hours<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Diflunisal<\/td>\n<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Naproxen (Naprosyn)<\/td>\n17-Dec<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Sulindac (Cinoril)<\/td>\n<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Meloxicam (Mobic)<\/td>\n15-20<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Nabumetone (Relafen)<\/td>\n22-30<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Piroxicam (Feldene)<\/td>\n45-50<\/td>\ndo not withhold<\/td>\nNo recommendation<\/td>\nNo recommendation<\/td>\n<\/td>\n<\/tr>\n
Abcximab (ReoPro)<\/td>\n8 \u2013 12
\nhours<\/td>\n		24 hours<\/td>\n<\/td>\nperi-procedural cardiac intervention; Multidisciplinary decision making.<\/td>\n<\/td>\n<\/tr>\n
Eptifibatide (Integrilin)<\/td>\n2.5 hours<\/td>\n4 \u2013 8 hours<\/td>\n<\/td>\nperi-procedural cardiac intervention; Multidisciplinary decision making.<\/td>\n<\/td>\n<\/tr>\n
Tirofiban (Aggrastat)<\/td>\n2 hours<\/td>\n<\/td>\nperi-procedural cardiac intervention; Multidisciplinary decision making.<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Etodolac<\/td>\n6-8 hr<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Oxaproxin<\/td>\n40-60 hr<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
REFERENCES:<\/td>\nNarouze S, et al. Interventional Spine and Pain Procedures.., Regional Anesthesia & Pain Medicine.\u00a02018;43(3):225-262.<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

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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.\u00a0 GFR < 50 = 6 doses. Consider anti-Xa activity or apixaban level [\u2026] <\/p>\n

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