Periprocedural Bridging Management of Anticoagulation

Wysokiński, Waldemar E.; McBane, Robert D.

doi:10.1161/circulationaha.112.092833

Cited by 69 publications

(36 citation statements)

References 22 publications

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“…There is recent support for radial access procedures regardless of anticoagulation status [23]. The indication for anticoagulation and the risk of thromboembolic events should be taken into account, as this will impact the decision for either bridging with unfractionated heparin or low molecular weight heparin (LMWH) or performing the procedure on anticoagulation; algorithms for bridging are available [24]. For patients on chronic warfarin therapy in whom anticoagulation can be held, the international normalized ratio (INR) should be obtained <24 hr prior to the procedure, with the goal INR of <1.8 for femoral procedures.…”

Section: Patient Preparation Within 48 Hr and Immediatementioning

confidence: 99%

“…Vitamin K administration and/or the administration of Fresh Frozen Plasma (FFP) may be considered when the INR cannot be corrected and the benefits of doing so outweigh the risks. For patients on TSOACs, the timing for discontinuation of therapy in advance of the procedure is impacted by renal function, but it is generally 1-2 days prior to the procedure [24,26]. Medication review and adjustment is also important for patients with diabetes, and insulin dosing should be adjusted to account for the time that the patient will be NPO.…”

Section: Patient Preparation Within 48 Hr and Immediatementioning

confidence: 99%

See 1 more Smart Citation

SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Association of interventional cardiology–Association canadienne de cardiologie d'intervention)*

Naidu

Aronow

Box

et al. 2016

Cathet Cardio Intervent

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Section: Patient Preparation Within 48 Hr and Immediatementioning

confidence: 99%

Section: Patient Preparation Within 48 Hr and Immediatementioning

confidence: 99%

SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Association of interventional cardiology–Association canadienne de cardiologie d'intervention)*

Naidu

Aronow

Box

et al. 2016

Cathet Cardio Intervent

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“…Given the lack of antidote, many experts have proposed that if CrCl is below 50 ml/min, dabigatran treatment should be stopped 7 days prior to a high-risk procedure, while in patients treated with rivaroxaban, anticoagulation should be stopped 5 days prior to such intervention. 26,27 Patients undergoing surgery with a high risk of life-threatening complications from bleeding, (e.g., spinal anesthesia, intracranial neurosurgery, intervention in the spinal cord, eye posterior chamber surgery) can have a TT performed preoperatively. Normal results indicate insignificant dabigatran levels.…”

mentioning

confidence: 99%

Practical aspects of new oral anticoagulant use in atrial fibrillation

Undas¹,

Pasierski²,

Windyga³

et al. 2014

Polish Archives of Internal Medicine

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Dabigatran, a direct thrombin inhibitor and 2 factor Xa inhibitors, rivaroxaban and apixaban, are target--specific oral anticoagulants (TSOACs) approved for prevention of stroke or systemic embolism in patients with nonvalvular atrial fibrillation (AF). Published data suggest that all 3 agents are at least as efficacious as dose-adjusted warfarin in stroke prevention. Because of their greater specificity, rapid onset of action, and predictable pharmacokinetics, TSOACs have some advantages over vitamin K antagonists, which facilitates their use in clinical practice. The current review addresses the practical questions relating to the use of TSOACs in AF patients based on the available data and personal experience. We discuss topics such as patient selection, renal impairment, drug interactions, switching between anticoagulants, laboratory monitoring, and the risk of bleeding along with its management. We will focus on the aspects of the optimization of treatment with TSOACs in stroke prevention. The understanding of these practical issues by clinicians and patients is of key importance for the safe and effective use of TSOACs in everyday practice. KEY WORDSapixaban, atrial fibrillation, dabigatran, rivaroxaban, stroke REVIEW ARTICLE Practical aspects of new oral anticoagulant use in atrial fibrillation 125With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation [ROCKET-AF], Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation [ARISTOTLE]). [4][5][6] Both dabigatran and apixaban were tested in low-to-moderate-risk patients (mean CHADS 2 [Congestive heart failure, Hypertension, Age, Diabetes, Stroke] score, about 2), whereas rivaroxaban was tested in high-risk patients (mean CHADS 2 score, 3.48). The studies, therefore, provide relatively little data on the efficacy of these drugs in patients at very high risk of stroke or systemic embolization.The recent European Society of Cardiology (ESC) Guidelines on the Management of AF recommend long-term anticoagulation in all patients with nonvalvular AF with at least moderate thromboembolic risk (1 point in the CHA 2 DS 2 VASc score, level of evidence A).7 Scores are presented in TABLE 3.In CHA 2 DS 2 -VASc, the score recommended by the ESC, in contrast to the CHADS 2 score, a relatively younger age (>65 years), female sex, and vascular disease are recognized as additional stroke risk factors in AF patients.7 A CHA 2 DS 2 -VASc score of 0 identifies a "truly low risk" group of subjects. Such patients constitute as few as 7% of the population of AF patients. 7 In conclusion, the current guidelines state that a vast majority of patients with paroxysmal or permanent AF not associated with reversible causes will benefit and should receive life-long oral anticoagulation. published in the Pol Arch Med Wewn). [1][2][3] The results of 3 key clinical trials with TSOACs have been summarized in TABLE 2. 1 Briefly, all 3 TSOACs were noninferior to VKAs in reducing stroke or systemic embolism in patients wi...

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“…Ein sehr einfaches, an verschiedene Publikationen angelehntes Schema als Vorschlag für das perioperative Management ist in Abb. 1 angeführt [8,60,67]. 2013 wurde von der "European Heart Rhythm Association" (EHRA) ein praxisorientierter Leitfaden publiziert, der die meisten Aspekte des Umgangs mit DOAK (so auch das perioperative Management) abdeckt [34].…”

Section: Perioperatives Managementunclassified

Konsensus-Statement – Schlaganfallprophylaxe bei nicht-valvulärem Vorhofflimmern unter besonderer Berücksichtigung der direkten oralen Antikoagulanzien

Pabinger¹,

Lang²,

Roithinger

et al. 2014

Wien Klin Wochenschr

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Periprocedural Bridging Management of Anticoagulation

Cited by 69 publications

References 22 publications

Practical aspects of new oral anticoagulant use in atrial fibrillation

Konsensus-Statement – Schlaganfallprophylaxe bei nicht-valvulärem Vorhofflimmern unter besonderer Berücksichtigung der direkten oralen Antikoagulanzien

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