Management of Antithrombotic Therapy in Patients Undergoing Invasive Procedures

Baron, Todd H.; Kamath, Patrick S.; McBane, Robert D.

doi:10.1056/nejmra1206531

Cited by 410 publications

(365 citation statements)

References 70 publications

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“…These recommendations are based more on pharmacological aspects of the medication but clinical trials are still missing in this regard. It has been proposed that dabigatran should be discontinued for 1 to 3 days in patients with creatinine clearance > 50 ml min and for 3 to 5 days if < 50 ml min 46,47,48 . Considering that spinal tap is a low bleeding risk procedure we recommend that the interval between the last dose of dabigatran and spinal tap is at least of one day for patients with normal renal function and three days for patients with creatinine clearance bellow 50 ml min.…”

Section: Dabigatranmentioning

confidence: 99%

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Lumbar puncture in patients using anticoagulants and antiplatelet agents

Domingues¹,

Bruniera

Brunale

et al. 2016

Arq. Neuro-Psiquiatr.

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The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmacology of these drugs, the thrombotic risk according to the underlying disease, and the urgency in cerebrospinal fluid analysis. Evaluating such information and a rigorous monitoring of neurological symptoms after lumbar puncture are crucial to minimize the risk of hemorrhage associated neurological deficits. An individualized patient decision-making and an effective communication between the assistant physician and the responsible for conducting the lumbar puncture are essential to minimize potential risks.

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Section: Dabigatranmentioning

confidence: 99%

“…It was suggested that apixaban should be interrupted 1-2 days before medical procedures in patients with normal renal function and 3 to 5 days if the creatinine clearance is bellow 50 ml min 46,47,48 .…”

Section: Apixabanmentioning

confidence: 99%

Lumbar puncture in patients using anticoagulants and antiplatelet agents

Domingues¹,

Bruniera

Brunale

et al. 2016

Arq. Neuro-Psiquiatr.

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“…In fact, it has been estimated that around one in 10 patients taking anticoagulants for cardioembolic prevention in non-valvular atrial fibrillation and mechanical heart diseases or prevention of venous thromboembolism recurrence, require surgery each year. 1 In the RE-LY study, approximately 25% of patients assigned to both doses of dabigatran and warfarin needed invasive surgical procedures. 2 The peri-procedural period represents a condition at high bleeding risk, requiring discontinuation of anticoagulants but this period is in any case at high risk of embolic complications due to discontinuation of antithrombotic drugs.…”

Section: Introductionmentioning

confidence: 99%

How to manage new oral anticoagulants in case of surgery

Imberti

2013

Ital J Med

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“…The ultimate goal is to minimize both thromboembolic events and major hemorrhage in the periprocedural period, and clinicians must carefully balance the risk of thromboembolic events with oral anticoagulation interruption against the risk of periprocedural bleeding with continued treatment, taking into account both patient-related and procedure-related risk factors. 16,17 In addition, there are some differences in the periprocedural management of oral anticoagulant therapy between elective and emergency procedures.…”

mentioning

confidence: 99%

“…[16][17][18][19] This area has been subject to much debate and discussion. 20,21 Periprocedural thromboembolic risk assessment…”

mentioning

confidence: 99%