UP Health System Marquette Pharmacy and …

1 UP Health System Marquette Pharmacy and Therapeutics Committee Medication Guideline Document created: 10/11. Revised: 08/16, 06/14, 02/12 Cross Reference: See Anticoagulant Guidelines for Use. UP Health System - Marquette A Duke LifePoint Hospital Marquette , MI 49855 This is a confidential professional/peer review and quality assessment document of Upper Peninsula Health System - Marquette of Marquette , MI. It is protected from disclosure pursuant to the provisions of MCL , MCL , MCL 21515, MCL , MCL , MCL , and other state and federal laws.

2 Unauthorized disclosure or duplication is absolutely prohibited. Interventional Radiology: Procedure Information for Anticoagulant Discontinuation Note: The guidelines below are ideal. If patients are considered to be at an increased risk from discontinuation of anticoagulants during this time period the Interventional Radiologist or PA / NP should be notified so alternatives can be discussed. Angiograms, Venograms with expected Angioplasty, IVC Filter Removal or placement: Argatroban 2 hours prior Dabigatran (Pradaxa ) 1 day prior (3 days for creatinine clearance (Clcr) <50 mL/min) Enoxaparin (Lovenox ) 12 hours prior Heparin Check with IR for shut off time Rivaroxaban (Xarelto ), apixaban (Eliquis ) 2 days prior Warfarin (Coumadin ) 3 days prior Do NOT discontinue clopidogrel (Plavix ),prasugrel (Effient ), ticagrelor (Brilinta ), cilostazol (Pletal ), or Aspirin Fistulogram, Shuntogram: Do NOT need to discontinue anticoagulants.

3 If patient is on Coumadin , the patient will need to have PT/INR the day prior and abnormal results should be sent to Acceptable INR is less than or equal to Biopsies (NON-Breast), Drainages, Seroma Drains, PFT (Perc Feeding Tube), Nephrostomy tube, Biliary tube: Argatroban 2 hours prior Aspirin 5 days prior Clopidogrel (Plavix ), prasugrel (Effient ), ticagrelor (Brilinta ) 5 days prior Dabigatran (Pradaxa ) 2 days prior (5 days for Clcr <50 mL/min) Enoxaparin (Lovenox ) 12 hours prior Heparin Check with Rivaroxaban (Xarelto ), apixaban (Eliquis ) 3 days prior Warfarin (Coumadin ) 5 days prior Do NOT discontinue cilostazol (Pletal ) Pain Procedures (myelogram, lumbar puncture, joint injections, nerve ablation)

4 See Anticoagulation Guidelines for Neuraxial Procedures for further information: Argatroban 2 hours prior Aspirin 5 days prior Cilostazol (Pletal ) 2 days prior Clopidogrel (Plavix ), prasugrel (Effient ), ticagrelor (Brilinta ) 5-7 days prior Dabigatran (Pradaxa ) 2 days prior (5 days for Clcr <50 mL/min) Enoxaparin (Lovenox ) 12 hours prior (for once daily prophylactic dosing) Heparin 4 hours prior Rivaroxaban (Xarelto ), apixaban (Eliquis ) 3 days prior Warfarin (Coumadin ) 5 days prior Thoracentesis Paracentesis.

5 Dabigatran (Pradaxa ) 1 day prior (3 days for Clcr <50 mL/min) Enoxaparin (Lovenox ) 12 hours prior Heparin Call IR unit for time Rivaroxaban (Xarelto ), apixaban (Eliquis ) 2 days prior Warfarin (Coumadin ) 3 days prior Do not need to discontinue clopidogrel (Plavix ), prasugrel (Effient ), ticagrelor (Brilinta ), or Aspirin Mediports, Mediport removal, Permcaths, Permcath removal, Groshongs, Tunnelled Catheters, Pleurx Catheter: Aspirin 5 days prior Clopidogrel (Plavix ), prasugrel (Effient ), ticagrelor (Brilinta ) 5 days prior Dabigatran (Pradaxa ) 2 days prior (5 days for Clcr <50 mL/min) Enoxaparin (Lovenox ) 12 hours prior Rivaroxaban (Xarelto ), apixaban (Eliquis ) 3 days prior Warfarin (Coumadin ) 5 days prior IR unit phone number 906-225-6970 Manager, Bob Kroll 906-361-4426