Anticoagulation and Antiplatelet Medications during Medium-Risk Procedures
E.g. Angiogram up to 7-F, venous interventions, transjugular liver biopsy, tunneled venous catheters, cholecystostomy, deep biopsy, abscess drainage, enteric tube placement, spinal procedure (epidural injection, lumbar puncture, vertebroplasty, kyphoplasty)
INR: Correct to ≤ 1.5
Platelets ≤ 50000/µL recommend platelet transfusion
| MEDICATION | INTERVAL B/N LAST DOSE & PROCEDURE | RESUMPTION AFTER PROCEDURE | REVERSAL AGENT |
|---|---|---|---|
| Abciximab (Reopro) | 24 h | 24 h | Platelet transfusion |
| Acetylsalicylic acid (ASA) low dose | None | Immediate | Desmopressin acetate (DDAVP) |
| Acetylsalicylic acid (ASA) high dose | 5 d | Immediate | Desmopressin acetate (DDAVP) |
| Apixaban (Eliquis) | 48 h | 48 h | Andexanet alfa |
| Argatroban | 4 h | 1 h | None |
| Bivaluridin (Angiomax) | 4 h | 1 h | None |
| Cilostazol (Pletal) | None | Immediate | Desmopressin |
| Clopidogrel (Plavix) | 5 d | Immediate | None |
| Dabigatran (Pradaxa) | 48 h | 48 h | Idarucizumab (praxbind) |
| Desirudin (Iprivask) | 4 h | 1 h | None |
| Eptifibatide (Integrilin) | 24 h | 24 h | Desmopressin |
| Fondaparinux | 36 h | 6 h | None |
| LMW Heparin Enoxaparin (Lovenox) (SQ) | 12 h | 6 h | None. Protamine partial temporary reversal |
| LMW Heparin Dalteparin (Fragmin) | Hold am of procedure | 4 h | Protamine incomplete antagonist |
| LMW Heparin Tinzaparin (Innohep) | Hold am of procedure | 4 h | Protamine incomplete antagonist |
| Prasugrel (Effient) | 5 d | 24 h | None |
| Rivaroxaban (Xarelto) | 48 h | 48 h | Andexanet alfa |
| NSAIDs | None | Immediate | None |
| Ticagrelor (Brilanta) | 5 d | 24 h | None |
| Tirofiban (Aggrastat) | 24 h | 24 h | Desmopressin acetate |
| Unfractionated heparin (IV) | 4 h | 1 h | Protamine |
| Unfractionated heparin (SQ) | 4 h | 1 h | Protamine |
| Warfarin | 5 d | 12 – 24 h | Vitamin K, Fresh frozen plasma, Prothrombin complex concentrate |