Anticoagulants

  • Xarelto (rivaroxaban)
    • factor Xa inhibitor
    • measure small elevation in INR/PTT; anti-factor Xa level
    • stop 24hrs prior to surgery
    • possible partial reversal with aPCC, may need 12hr re-dosing.
  • Eliquis (apixaban)
    • factor Xa inhibitor
    • measure small elevation in INR/PTT; anti-factor Xa level
    • stop 48hrs prior to surgery
    • possible partial reversal with aPCC, may need 12hr re-dosing.
  • Savaysa (edoxaban)
    • factor Xa inhibitor
    • measure small elevation in INR/PTT
    • stop 24hrs prior to surgery
    • possible partial reversal with aPCC, may need 12hr re-dosing.
  • Pradaxa (dabigatran)
    • direct thrombin inhibitor
    • measure elevated INR/PTT
    • stop 1-2d prior to surgery if CrCl>50ml/min or stop 3-5d prior to surgery if CrCl<50ml/min; may need longer times for major surgery
    • partial reversal with PCC and dialysis
    • full reversal with idarucizumab 2.5g x2 15min apart; immediate onset; lasts 24hrs.
  • Argatroban
    • direct thrombin inhibitor
    • measure elevated INR/PTT
    • stop 4hrs before surgery
    • no reversal
  • bivalirudin
    • direct thrombin inhibitor
    • elevated PTT
    • stop 2hrs before surgery
    • reverse partially with dialysis and rFVIIa
  • fondiaparinux
    • factor Xa inhibitor
    • measure possibly elevated anti-factor Xa level
    • stop 4d before surgery
    • possible partial reversal with aPCC, may need 12hr re-dosing; rFVIIa
  • Deltaparin / Lovenox LMWH
    • indirect thrombin inhibitor
    • measure anti-factor Xa level
    • stop 1d prior to surgery
    • partial reversal with protamine
  • Plavix (clopidogrel)
    • blocks ADP receptor on platelets
    • measure platelet function assay, ROTEM, TEG with platelet mapping
    • stop 7d before surgery
    • partial reversal options include: 10U platelets, DDAVP ug/kg IV re-dosed PRN 8-12hrs, possibly TXA
  • Pletal (cilostazol)
    • phosphodiesterase inhibitor (increases cAMP), reversible platelet aggregation inhibitor
    • no measure
    • unsure, may stop 7d before surgery
    • no reversal
  • Effient (prasugel)
    • blocks ADP receptor on platelets
    • stop 7d before surgery
    • partial reversal options include: 10U platelets, DDAVP ug/kg IV re-dosed PRN 8-12hrs, possibly TXA
  • Brillanta (ticagrelor)
    • reversibly blocks ADP receptor
    • stop 5d before surgery
    • partial reversal options include: 10U platelets, DDAVP ug/kg IV re-dosed PRN 8-12hrs, possibly TXA
  • Ticlid (ticlopidine)
    • blocks ADP receptor on platelets
    • stop 10-14d before surgery
    • partial reversal options include: 10U platelets, DDAVP ug/kg IV re-dosed PRN 8-12hrs, possibly TXA
  • Persantine (dipyridamole)
    • increases cAMP
    • stop 48hrs before surgery
  • Aggrenox (asa/dipyridamole)
    • antiplatelet COX inhibitor and increases cAMP
    • stop 7d before surgery
    • partial reversal options: platelets
  • ReoPro (abciximab)
    • inhibits GP IIb/IIIa
    • stop 36-48hrs before surgery
    • partial reversal options include: 10U platelets, DDAVP ug/kg IV re-dosed PRN 8-12hrs, TXA
  • Integrilin (eptifibatide)
    • inhibits GP IIb/IIIa
    • stop 4-6hrs before surgery
    • partial reversal with DDAVP; wait to give platelets until medication is cleared

References:
individual drug web sites
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