Clinical Practice Guide On Antithrombotic Drug Dosing and Management of Antithrombotic Drug-Associated Bleeding Complications in Adults
Clinical Practice Guide On Antithrombotic Drug Dosing and Management of Antithrombotic Drug-Associated Bleeding Complications in Adults
Clinical Practice Guide On Antithrombotic Drug Dosing and Management of Antithrombotic Drug-Associated Bleeding Complications in Adults
QUICK REFERENCE
Enoxaparin (Lovenox®), Tinzaparin (Innohep®)] and Fondaparinux1 (Arixtra®)
Abbreviations: PCC, prothrombin complex concentrates, rFVIIa, recombinant factor VIIa Aspirin, Aspirin/Dipyridamole (Aggrenox®), Clopidogrel (Plavix®), Prasugrel (Effient®),
Non-Urgent Urgent (Not Bleeding) Urgent (Bleeding) * Commonly available tests to assess for presence of dabigatran are the aPTT and for
rivaroxaban the PT. These tests may be prolonged when dabigatran and rivaroxaban are used
Ticagrelor (Brilinta®) Clinical Practice Guide
General Considerations
• Hold day of procedure
• Once-daily regimens
• Wait 12-24 hours if possible
• Consider protamine sulfate
• HASHTI
• Protamine sulfate
at recommended doses but they do not reliably measure the anticoagulant activity. Therapeutic
levels of apixaban may not elevate the PT. To measure anticoagulant activity, the ecarin clotting
1. Plasma half-lives on Antithrombotic Drug
° ½ dose day prior
• Twice-daily regimens
if delay not possible for high
bleeding risk procedure
• Consider rVIIa
time (ECT) or dilute thrombin time for dabigatran and chromogenic anti-Factor Xa assays using
validated calibrators and controls may be used for rivaroxaban and apixaban.
a. Clopidogrel, dipyridamole, prasugrel, ticagrelor: 7-10 hours
b. Low-dose aspirin (150 mg daily): 2-4.5 hours Dosing and Management
° Hold evening dose day
prior ** Dabigatran, rivaroxaban and apixaban are excreted in the urine, therefore maintain adequate
diuresis. Rivaroxaban and apixaban are highly protein bound so dialysis is not effective.
c. Overdose aspirin (>4000 mg): 15-30 hours
2. Reversibility of antiplatelet effect of Antithrombotic Drug-
Fondaparinux has no specific antidote
1
QUICK REFERENCE
Enoxaparin (Lovenox®), Tinzaparin (Innohep®)] and Fondaparinux1 (Arixtra®)
Abbreviations: PCC, prothrombin complex concentrates, rFVIIa, recombinant factor VIIa Aspirin, Aspirin/Dipyridamole (Aggrenox®), Clopidogrel (Plavix®), Prasugrel (Effient®),
Non-Urgent Urgent (Not Bleeding) Urgent (Bleeding) * Commonly available tests to assess for presence of dabigatran are the aPTT and for
rivaroxaban the PT. These tests may be prolonged when dabigatran and rivaroxaban are used
Ticagrelor (Brilinta®) Clinical Practice Guide
General Considerations
• Hold day of procedure
• Once-daily regimens
• Wait 12-24 hours if possible
• Consider protamine sulfate
• HASHTI
• Protamine sulfate
at recommended doses but they do not reliably measure the anticoagulant activity. Therapeutic
levels of apixaban may not elevate the PT. To measure anticoagulant activity, the ecarin clotting
1. Plasma half-lives on Antithrombotic Drug
° ½ dose day prior
• Twice-daily regimens
if delay not possible for high
bleeding risk procedure
• Consider rVIIa
time (ECT) or dilute thrombin time for dabigatran and chromogenic anti-Factor Xa assays using
validated calibrators and controls may be used for rivaroxaban and apixaban.
a. Clopidogrel, dipyridamole, prasugrel, ticagrelor: 7-10 hours
b. Low-dose aspirin (150 mg daily): 2-4.5 hours Dosing and Management
° Hold evening dose day
prior ** Dabigatran, rivaroxaban and apixaban are excreted in the urine, therefore maintain adequate
diuresis. Rivaroxaban and apixaban are highly protein bound so dialysis is not effective.
c. Overdose aspirin (>4000 mg): 15-30 hours
2. Reversibility of antiplatelet effect of Antithrombotic Drug-
Fondaparinux has no specific antidote
1
QUICK REFERENCE
Enoxaparin (Lovenox®), Tinzaparin (Innohep®)] and Fondaparinux1 (Arixtra®)
Abbreviations: PCC, prothrombin complex concentrates, rFVIIa, recombinant factor VIIa Aspirin, Aspirin/Dipyridamole (Aggrenox®), Clopidogrel (Plavix®), Prasugrel (Effient®),
Non-Urgent Urgent (Not Bleeding) Urgent (Bleeding) * Commonly available tests to assess for presence of dabigatran are the aPTT and for
rivaroxaban the PT. These tests may be prolonged when dabigatran and rivaroxaban are used
Ticagrelor (Brilinta®) Clinical Practice Guide
General Considerations
• Hold day of procedure
• Once-daily regimens
• Wait 12-24 hours if possible
• Consider protamine sulfate
• HASHTI
• Protamine sulfate
at recommended doses but they do not reliably measure the anticoagulant activity. Therapeutic
levels of apixaban may not elevate the PT. To measure anticoagulant activity, the ecarin clotting
1. Plasma half-lives on Antithrombotic Drug
° ½ dose day prior
• Twice-daily regimens
if delay not possible for high
bleeding risk procedure
• Consider rVIIa
time (ECT) or dilute thrombin time for dabigatran and chromogenic anti-Factor Xa assays using
validated calibrators and controls may be used for rivaroxaban and apixaban.
a. Clopidogrel, dipyridamole, prasugrel, ticagrelor: 7-10 hours
b. Low-dose aspirin (150 mg daily): 2-4.5 hours Dosing and Management
° Hold evening dose day
prior ** Dabigatran, rivaroxaban and apixaban are excreted in the urine, therefore maintain adequate
diuresis. Rivaroxaban and apixaban are highly protein bound so dialysis is not effective.
c. Overdose aspirin (>4000 mg): 15-30 hours
2. Reversibility of antiplatelet effect of Antithrombotic Drug-
Fondaparinux has no specific antidote
1
QUICK REFERENCE
Enoxaparin (Lovenox®), Tinzaparin (Innohep®)] and Fondaparinux1 (Arixtra®)
Abbreviations: PCC, prothrombin complex concentrates, rFVIIa, recombinant factor VIIa Aspirin, Aspirin/Dipyridamole (Aggrenox®), Clopidogrel (Plavix®), Prasugrel (Effient®),
Non-Urgent Urgent (Not Bleeding) Urgent (Bleeding) * Commonly available tests to assess for presence of dabigatran are the aPTT and for
rivaroxaban the PT. These tests may be prolonged when dabigatran and rivaroxaban are used
Ticagrelor (Brilinta®) Clinical Practice Guide
General Considerations
• Hold day of procedure
• Once-daily regimens
• Wait 12-24 hours if possible
• Consider protamine sulfate
• HASHTI
• Protamine sulfate
at recommended doses but they do not reliably measure the anticoagulant activity. Therapeutic
levels of apixaban may not elevate the PT. To measure anticoagulant activity, the ecarin clotting
1. Plasma half-lives on Antithrombotic Drug
° ½ dose day prior
• Twice-daily regimens
if delay not possible for high
bleeding risk procedure
• Consider rVIIa
time (ECT) or dilute thrombin time for dabigatran and chromogenic anti-Factor Xa assays using
validated calibrators and controls may be used for rivaroxaban and apixaban.
a. Clopidogrel, dipyridamole, prasugrel, ticagrelor: 7-10 hours
b. Low-dose aspirin (150 mg daily): 2-4.5 hours Dosing and Management
° Hold evening dose day
prior ** Dabigatran, rivaroxaban and apixaban are excreted in the urine, therefore maintain adequate
diuresis. Rivaroxaban and apixaban are highly protein bound so dialysis is not effective.
c. Overdose aspirin (>4000 mg): 15-30 hours
2. Reversibility of antiplatelet effect of Antithrombotic Drug-
Fondaparinux has no specific antidote
1