CHEST 2012: Bridging Flashcards Preview

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Flashcards in CHEST 2012: Bridging Deck (26)
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1

VKA interruption

5 days before surgery

2

VKA resumption when temporarily interrupted prior to surgery

12 to 24 hours after surgery when adequate hemostasis (evening of or following morning)

3

If mechanical heart valve, AF, or VTE at low risk for thromboembolism, decision should be to

Do Not bridge

4

If minor dental procedure

Continue VKA with coadministration of a prohemostatic agent (ex. fibrinogen, factor 7a) OR stop VKA 2-3 days prior to procedure

5

If only takes ASA and minor dental or skin procedure

Keep taking ASA

6

If minor skin procedure and taking VKA

Local hemostasis and continue VKA

7

If cataract surgery and has VKA

Continue VKA

8

If taking only ASA and needing non-cardiac surgery

1) at moderate to high risk of CV events

2) at low risk of CV events

1) Continue ASA

2) Stop ASA 7 - 10 days before surgery

9

If taking ASA and require CABG

Continue ASA

10

If DAPT and require CABG

Continue ASA
Stop clopidogrel/prasugrel 5 days before surgery

11

If DAPT and stented and require surgery

And if those are not options

Defer 6 weeks after BMS stent placement
Defer 6 months after DES stent placement

If those are not options, continue DAPT

12

If getting therapeutic IV UFH for bridging, when to stop

4 - 6 hours before surgery

13

If getting therapeutic LMWH for bridging, when to stop preoperative LMWH

24 hours before

14

High Risk for VTE per risk stratification

VTE within 3 months or severe thrombophilia

15

Low risk for VTE per risk stratification

VTE more than 12 months ago and no other risk factors

16

Dabigatran interruption (when to stop and when to restart)
CrCl 30 - 50
CrCl > 50

CrCl 30 - 50:
Last dose 3 days before the procedure if low bleed risk, 4-5 days before the procedure if high bleed risk
CrCl > 50:
Last dose 2 days before the procedure if low bleed risk,
3 days before procedure if high bleed risk

Resume 24 hours after procedure if low bleed risk
Resume 2-3 days after procedure if high bleed risk

17

Rivaroxaban or Apixaban interruption for procedure

CrCl 15 - 30
CrCl > 30

CrCl 15 - 30: individualized

CrCl > 30:
Last dose 2 days before procedure for low bleeding risk
Last dose 3 days before procedure for high bleeding risk

Resume 24 hours after procedure for low bleeding risk
Resume 2-3 days after procedure for high bleeding risk

18

Edoxaban interruption for procedure

CrCl > 50

Last dose 2 days before procedure if low bleeding risk
Last dose 3 days before procedure if high bleeding risk

Resume 24 hours after if low bleeding risk
Resume 2-3 days after if high bleeding risk

19

When to restart UFH for bridging procedure

Restart within 12 hours after procedure

20

When to restart LMWH for bridging procedure

Restart within 24 hours after procedure

21

UFH aPTT goal for procedure

1.5 to 2 x control

22

When to start parenteral anticoagulation for bridging

Approximately 3 days before procedure

23

When to stop warfarin for bridging

Approximately 5 days before procedure

24

When to give oral vitamin K prior to procedure (INR and how much to give)

When INR is > 1.5
Consider 1 - 2.5 mg PO

25

When to restart warfarin post procedure

Consider either the evening of procedure or the morning after the procedure

26

When to avoid restarting an anticoagulant post procedure

If high bleeding risk