Anticoagulant Guidelines ASH
Anticoagulant Guidelines ASH
Anticoagulant Guidelines ASH
QUICK REFERENCE
Non-urgent: Hold further doses of dabigatran Aspirin, Dipyridamole/Persantine/Aggrenox, Clopidogrel/Plavix,
CrCl > 50 ml/min: Hold 1-2 days
CrCl < 50 ml/min: Hold 3-5 days
Ticlopidine/Ticlid, Prasugrel/Effient, Ticagrelor/Brilinta 2011 Clinical
General Considerations
Consider longer times for major surgery, placement of spinal or
epidural catheter or port 1. Half-lives Practice Guide on
Anticoagulant Dosing
a. Clopidogrel, ticlopidine, dipyridamole, prasugrel, ticagrelor: 7-10 hours
Urgent:
B ,OW
DOSE ASPIRIN MG DAILY
HOURS
Hold dabigatran and check aPTT C /VERDOSE ASPIRIN MG
HOURS
2. Reversibility of anti-platelet effect
a. Aspirin, clopidogrel, ticlopidine, and prasugrel inhibit platelet function
and Management
Normal aPTT
Unlikely dabigatran is
Prolonged aPTT
Dabigatran present and may
for lifetime of platelet. Inhibition takes 7-10 days to resolve as new
platelets are generated.
of Anticoagulant-
Associated Bleeding
contributing to bleeding be contributing to bleeding b. Ticagrelor is a reversible inhibitor, so platelet function normalizes after
drug clearance.
Complications in
3. Circulating drug or active metabolites can inhibit transfused platelets.
No antidote available -UST CONSIDER INDICATION FOR USE IN DECISION TO REVERSE
HASHTI* For bleeding consider: a. Risk of coronary stent occlusion (which can be fatal) within 3 months
PCC
activated PCC (FEIBA)
of bare metal stent implantation; period of risk is likely longer for drug-
eluting stents.
Adults
rFVIIa
hemodialysis b. Consult cardiologist if uncertain.
Reversal of Antiplatelet Agents
Reassess patient
Non-Urgent Urgent (Not Bleeding) Urgent (Bleeding)
Repeat abnormal coagulation tests*
s $ISCONTINUE AGENT s #ONSIDER PLATELET TRANSFUSION s HASHTI
Abbreviations: PCC = prothrombin complex concentrates; rFVIIa = recombinant factor VIIa 5-10 days prior to prior to high risk bleeding s 0LATELET TRANSFUSION
* Dabigatran primarily excreted in the urine, therefore maintain adequate diuresis procedure procedures
Experimental evidence supports these agents but no clinical trial data available; PCC may not
lower PTT