Anticoagulation and Antiplatelet Medications during Low-Risk Procedures:
Biopsy and drainage – Superficial (breast, superficial bone, lymph node)
Bone marrow biopsy
Catheter exchanges (G Tubes, Biliary, Nephrostomy etc)
Angiogram using sheath <=6 French for diagnosis, embolization. Angioplasty and stenting are considered high-risk
Chest tube
Diagnostic venograms
Dialysis access interventions
Fine Needle aspirations (Lymph nodes, thyroids)
Joint injections including lumbar facet injections (Cervical facet injections are considered high-risk)
Nontunneled venous catheters
Paracentesis,
IVC filter placement
IVC filter removal – simple
Thoracentesis
Transjugular liver biopsy
Trigger point injections including piriformis
Tunneled venous catheter placement/removal (including ports)
INR: Routine evaluation not needed. Consider screening for high-risk patients, patients on warfarin or heparin drip. Correct to ≤ 2.0 – 3.0.
For e.g. For Ports, Tunneled catheters – INR < 2.0
For angiograms INR < 1.8 for femoral access and < 2.2 for radial access.
Platelets. Routine evaluation not needed. Consider screening for high-risk patients. Consider platelet transfusion for value ≤ 20000/µL
For patients with Chronic liver disease: INR is not applicable, Platelet count > 20, Fibrinogen > 100
For Platelet count < 20 and in patients with large spleen administer a dose of platelets
For Fibrinogen < 100 administer 1 dose (body weight < 80 kg) or 2 doses (body weight > 80 kg) of Cryoprecipitate.
| MEDICATION | INTERVAL B/N LAST DOSE & PROCEDURE | RESUMPTION AFTER PROCEDURE | REVERSAL AGENT |
|---|---|---|---|
| Abciximab (Reopro) | 24 h | 24 h D/W cardiology | Platelet transfusion |
| Aspirin low dose | None | NA | Desmopressin acetate (DDAVP) |
| Aspirin high dose | None | NA | Desmopressin acetate (DDAVP) |
| Apixaban (Eliquis) | None | NA | Andexanet alfa |
| Aspirin/Dipyridamole(Aggrenox) | None | NA | |
| Argatroban(Acova) | None | NA | None |
| Betrixaban(Bevyxxa) | None | NA | |
| Bivaluridin (Angiomax) | None | NA | None |
| Cilostazol (Pletal) | None | NA | Desmopressin |
| Cangrelor(Kengreal) | D/w Cardiology. If emergent – 1 hour | D/w Cardiology | |
| Clopidogrel (Plavix) | None | NA | None |
| Dabigatran (Pradaxa) | None | NA | Idarucizumab (praxbind) |
| Desirudin (Iprivask) | None | NA | None |
| Edoxaban(Savaysa) | None | NA | |
| Eptifibatide (Integrilin) | 4-8 hr | 24 h D/W Cardiology | Desmopressin |
| Fondaparinux(Arixtra) | None | NA | None |
| LMW Heparin Enoxaparin (Lovenox) (SQ) | None | NA | None. Protamine partial temporary reversal |
| LMW Heparin Dalteparin (Fragmin) | None | NA | Protamine incomplete antagonist |
| LMW Heparin Tinzaparin (Innohep) | None | NA | Protamine incomplete antagonist |
| Prasugrel (Effient) | None | NA | None |
| Rivaroxaban (Xarelto) | None | NA | Andexanet alfa |
| NSAIDs | None | NA | None |
| Ticagrelor (Brilanta) | None | NA | None |
| Tirofiban (Aggrastat) | None | NA | Desmopressin acetate |
| Unfractionated heparin (IV) | None | NA | Protamine |
| Unfractionated heparin (SQ) | None | NA | Protamine |
| Warfarin | Target INR <= 3 Consider bridging for high thrombosis risk pt | NA or same day for bridged patients | Vitamin K, Fresh frozen plasma, Prothrombin complex concentrate |