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pharmaceutical anticoagulant
Indications:
- hypercoagulable state
- thrombosis
- atrial fibrillation
- prophylaxis for venous thromboembolism
Contraindications:
- hemorrhage
- thrombocytopenia
- hemophilia
Adverse effects:
- hemorrhage
- GI bleed
- coadministriation of proton pump inhibitor may decrease risk of GI bleed [5]
- hemorrhagic stroke
Management:
- in general, continue anticoagulant during procedures with low risk of bleeding (upper endoscopy, dental precedure, skin surggery, or cataract extraction
- for warfarin, check INR 24-72 hours before the procedure
- if INR > 4, restore INR to therapeutic level prior to the
- in general, stop most anticoagulants before a colonoscopy due to increased risk of bleeding with polypectomy
- if polypectomy is not performed, restart antithrombotics immediately following the procedure.
- if polypectomy is performed
- restart warfarin about 12 hours after the procedure
- restart dabigatran, rivaroxaban, apixaban about 48-72 hours after the procedure
Interactions
drug interactions
drug adverse effects of antithrombotic agent(s)
Related
coagulation
Specific
anisindione (Miradon)
bivalirudin (Angiomax)
coagulation factor Xa inhibitor
coumarin; chromen-2-onel cumarin; 1,2-benzopyrone; tonka bean camphor (Rattex)
danaparoid (Orgaran)
dicumarol (dicoumarol)
direct oral anticoagulant; novel oral anticoagulant (DOAC, NOAC)
fondaparinux (Arixtra)
heparin
heparinoid
phenprocoumon (Marcoumar, Marcumar, Falithrom)
thrombin inhibitor
warfarin (Coumadin, Panwarfin, Jantoven)
General
anticoagulant
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Prescriber's Letter 18(10): 2011
Detail-Document#: 271020
Comparison of Oral Anticoagulants and Antiplatelets
(subscription needed) http://www.prescribersletter.com
- Prescriber's Letter 18(12): 2011
Comparison of Oral Antithrombotics
Detail-Document#: 271220
(subscription needed) http://www.prescribersletter.com
- Prescriber's Letter 19(12): 2012
Comparison of Oral Antithrombotics
Detail-Document#: 281222
(subscription needed) http://www.prescribersletter.com
- Prescriber's Letter 20(5): 2013
Managing Antithrombotics Before Minor Procedures
Detail-Document#: 290521
(subscription needed) http://www.prescribersletter.com
- Ray WA, Chung CP, Murray KT et al
Association of Oral Anticoagulants and Proton Pump Inhibitor
Cotherapy With Hospitalization for Upper Gastrointestinal
Tract Bleeding.
JAMA. 2018;320(21):2221-2230
PMID: 30512099
https://jamanetwork.com/journals/jama/fullarticle/2717474