Thrombolytics |
Streptokinase |
Avoid blockade |
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Urokinase |
Fibrinolytics |
T-PA (alteplase, tecneteplase) |
Low Molecular Weight Heparin (LMWH) |
Enoxaparin (prophylactic) |
> 12 hours |
> 12 hours |
>12 hours |
> 4 hours |
Enoxaparin (therapeutic) |
> 24 hours |
> 24 hours |
> 24 hours if low postoperative bleeding risk surgery and > 48 hours if high risk |
> 4 hours |
Dalteparin 5000 U.day-1 (prophylactic) |
> 12 hours |
> 12 hours |
> 12 hours |
> 4 hours |
Dalteparin 200 U. kg-1.day-1 or 120 mg 2×/day (therapeutic) |
> 24 hours |
> 24 hours |
> 24 hours if low postoperative bleeding risk surgery and > 48 hours if high risk |
> 4 hours |
Tinzaparin (prophylactic) |
> 12 hours |
> 12 hours |
> 12 hours |
> 4 hours |
Tinzaparin 175 U. kg-1.day-1 (therapeutic) |
> 24 hours |
> 24 hours |
> 24 hours if low postoperative bleeding risk surgery and > 48 hours if high risk |
> 4 hours |
Nadroparin (prophylactic) |
> 12 hours |
> 12 hours |
> 12 hours |
> 4 hours |
Nadroparin 86 U. kg-1 2×/day or 171 U. kg-1.day-1 (therapeutic) |
> 24 hours |
> 24 hours |
> 24 hours if low postoperative bleeding risk surgery and > 48 hours if high risk |
> 4 hours |
Unfractionated heparin (UFH) |
IV UFH |
4-6 hours (check if clotting is normal) |
4-6 hours (check if clotting is normal) |
1 hour |
1 hour |
UFH 15,000 U.day-1 (prophylactic - low dose) |
SC 4-6 hours |
SC 4-6 hours |
1 hour |
1 hour |
UFH 7,500-10,000 U 2×/day or daily dose < 20000 U (prophylactic - high dose) |
SC 12 hours |
SC 12 hours |
1 hour |
1 hour |
UFH > 10,000 U per dose or daily dose > 20,000 U (therapeutic) |
SC 24 hours |
SC 24 hours |
1 hour |
1 hour |
Anti- factor Xa agents |
Fondaparinux (Arixtra®) - IV |
36-42 hours |
Do not install catheter Inadvertent dose: 2 half-lives |
12 hours |
12 hours |
Rivaroxaban (Xarelto®) |
72 hours |
Do not install catheter Inadvertent dose: 2 half-lives |
6 hours |
6 hours |
Apixabana (Eliquis®) |
72 hours |
Do not install catheter Inadvertent dose: 2 half-lives |
6 hours |
6 hours |
Edoxaban (Lixiana®, Savaysa®) |
72 hours |
Do not install catheter Inadvertent dose: 2 half-lives |
6 hours |
6 hours |
Betrixaban (Bevyxxa®) - VO |
72 hours |
Do not install catheter Inadvertent dose: 2 half-lives |
5 hours |
5 hours |
Direct thrombin inhibitors (Anti-factor IIa agents) |
Desirudin (Revasc®) - IV |
Avoid blockade |
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Bivalirudin (Angiomax®) - IV |
Avoid blockade |
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Argatroban (Acova®) - IV |
Avoid blockade |
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Dabigatran (Pradaxa®) - VO |
ClCr < 30 mL.min-1 - do not do ClCr 30-49 mL.min-1, 5 days ClCr 50-79 mL.min-1, 4 days ClCr > 80 mL.min-1, 3 days ClCr unknown, 5 days |
Do not insert catheter Inadvertent dose: 2 half-lives |
6 hours |
6 hours |
Vitamin K antagonists |
Warfarin |
5 days with INR ≤ 1.5 |
Discontinue if INR < 1.5 (if it was reintroduced it can be discontinued between 12 and 24 hours after - Unknown risk if 48 hours after) |
Right after puncture |
Right after catheter removal |
Antiplatelet - non-steroid anti- inflammatory (NSAID) |
Aspirin, ibuprofen, diclofenaco and indomethacin |
No restrictions. Careful with concomitant use of other drugs that affect coagulation |
No restrictions. Careful with concomitant use of other drugs that affect coagulation |
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Antiplatelet Thienopyridines (P2Y12 inhibitors) |
Ticlopidine (Ticlid®) |
10 days |
Catheter can remain for maximum 48 hours as long as no loading dose is given |
24 hours |
24 hours |
Clopidogrel (Plavix®) |
5-7 days |
Catheter can remain for maximum 48 hours as long as no loading dose is given |
24 hours |
24 hours |
Prasugrel (Effient®) |
7-10 days |
Do not install catheter |
24 hours |
24 hours |
Antiplatelets (ADP inhibitors) |
Ticagrelor (Brilinta®) |
5-7 days |
do not insert catheter |
24 hours |
24 hours |
Cangrelor (Kengreal®) |
3 hours Short half-life - use as bridge therapy |
Remove catheter before reintroduction of cangrelor |
8 hours |
8 hours |
Antiplatelet - antagonists GP IIa/IIIa (IGP) |
Abciximab (Reopro®) |
24-48 hours |
24-48 hours |
Contraindicated for 4 weeks after surgical procedure. Inadvertent dose: 8-12 hours |
Contraindicated for 4 weeks after surgical procedure. Inadvertent dose: 8-12 hours |
Eptifibatide (Integrilin®) |
4-8 hours |
4-8 hours |
Tirofiban (Aggrastat®) |
4-8 hours |
4-8 hours |
Other antiplatelet drugs (phosphodiesterase Inhibitors) |
Cilostazol (Pletal®) |
2 days |
Remove catheter before reintroduction of cilostazol |
6 hours |
6 hours |
Dypiridamol (Persantin®) |
24 hours. Major bleeding risk if associated with aspirin. |
Remove catheter before reintroduction of dypiridamol |
6 hours |
6 hours |
Herbal therapy |
Ginkgo biloba, ginseng and garlic |
No additional risk if isolated use |
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