Copy of Snippet "Anti-Coagulant Medication & Guidelines"

Guidelines for Anti-Coagulant medication

Anti-Coagulant Medication: {note}{formmenu: default=No; Yes; name=acm}{endnote}{if: acm==No}not taking any anti-coagulant medication, such as a Warfarin, Eliquis, Xarelto or Pradaxa.{else}{note}Select Anti-Coagulant Medication{endnote}{formmenu: name=anti_coagulant_drug; - Select Anti-Coagulant Medication -; Warfarin; Eliquis (Apixaban); Xarelto (Rivaroxaban); Pradaxa (Dabigatran)}{note}Reason for taking Anti-Coagulant Medication:{formmenu: name=coag_reason; default=Select reason for taking anti-coagulant medication;AF without valvular disease;AF and mitral stenosis;Prosthetic metal heart valve and AF;Prosthetic metal heart valve in mitral position;Prosthetic metal heart valve in aortic position;Xenograft heart valve;Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis;Less than 6-months after Pulmonary Embolism or Deep Venous Thrombosis;Thrombophilia syndromes}{endnote} -> Guidelines about stopping anti-coagulant medication before and after procedure: {if: anti_coagulant_drug == "Warfarin" and includes(["AF without valvular disease", "Xenograft heart valve", "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis"], coag_reason)}Stop Warfarin 5 days before the procedure + check INR prior to the procedure is < 1.5; restart Warfarin on the evening following the procedure with usual daily dose + check INR 1 week later to ensure adequate anti-coagulation.{elseif: anti_coagulant_drug == "Warfarin" and includes(["AF and mitral stenosis", "Prosthetic metal heart valve and AF", "Prosthetic metal heart valve in mitral position", "Prosthetic metal heart valve in aortic position", "Less than 6-months after Pulmonary Embolism or Deep Venous Thrombosis", "Thrombophilia syndromes"], coag_reason)}Stop warfarin 7 days before procedure + start LMWH (Clexane) 2 days after stopping warfarin + give last dose of LMWH (Clexane) ≥ 24 hours before procedure; restart Warfarin on the same evening of procedure with usual daily dose continue LMWH (Clexane) until INR > 1.5.{elseif: anti_coagulant_drug == "Eliquis (Apixaban)" and includes(["AF without valvular disease", "Xenograft heart valve", "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis"], coag_reason)}Omit Eliquis for 2-days before the procedure; restart Eliquis on the evening following the procedure with usual daily dose if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart restart Eliquis on the evening of procedure with usual daily dose.{elseif: anti_coagulant_drug == "Eliquis (Apixaban)" and includes(["AF and mitral stenosis", "Prosthetic metal heart valve and AF", "Prosthetic metal heart valve in mitral position", "Prosthetic metal heart valve in aortic position", "Less than 6-months after Pulmonary Embolism or Deep Venous Thrombosis", "Thrombophilia syndromes"], coag_reason)}Omit Eliquis for 3-days before the procedure + start LMWH (Clexane) 24 hours after stopping Eliquis; take last dose of LMWH ≥24 hours before procedure (day before procedure); restart Eliquis on the evening following the procedure with usual daily dose if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart restart Eliquis on the evening of procedure with usual daily dose; stop taking LMWH 2-days after restarting Eliquis.{elseif: anti_coagulant_drug == "Xarelto (Rivaroxaban)" and includes(["AF without valvular disease", "Xenograft heart valve", "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis"], coag_reason)}Omit Xarelto for 2-days before the procedure; restart Xarelto on the evening following the procedure with usual daily dose if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart restart Xarelto on the evening of procedure with usual daily dose.{elseif: anti_coagulant_drug == "Xarelto (Rivaroxaban)" and includes(["AF and mitral stenosis", "Prosthetic metal heart valve and AF", "Prosthetic metal heart valve in mitral position", "Prosthetic metal heart valve in aortic position", "Less than 6-months after Pulmonary Embolism or Deep Venous Thrombosis", "Thrombophilia syndromes"], coag_reason)}Omit Xarelto for 3-days before the procedure + start LMWH (Clexane) 24 hours after stopping Xarelto take last dose of LMWH ≥24 hours before procedure (day before procedure); restart Xarelto on the evening following the procedure with usual daily dose if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart restart Xarelto on the evening of procedure with usual daily dose; stop taking LMWH 2-days after restarting Xarelto.{elseif: anti_coagulant_drug == "Pradaxa (Dabigatran)" and includes(["AF without valvular disease", "Xenograft heart valve", "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis"], coag_reason)}Omit Pradaxa for 2-days before the procedure; restart Pradaxa on the evening following the procedure with usual daily dose if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart restart Pradaxa on the evening of procedure with usual daily dose; (if eGFR between 30-50, stop Pradaxa ≥ 3-days before procedure; in any patient with rapidly deteriorating renal function -> consult a haematologist).{elseif: anti_coagulant_drug == "Pradaxa (Dabigatran)" and includes(["AF and mitral stenosis", "Prosthetic metal heart valve and AF", "Prosthetic metal heart valve in mitral position", "Prosthetic metal heart valve in aortic position", "Less than 6-months after Pulmonary Embolism or Deep Venous Thrombosis", "Thrombophilia syndromes"], coag_reason)}Omit Pradaxa for 3-days before the procedure + start LMWH (Clexane) 24 hours after stopping Pradaxa take last dose of LMWH ≥24 hours before procedure (day before procedure); restart Pradaxa on the evening following the procedure with usual daily dose if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart restart Pradaxa on the evening of procedure with usual daily dose; stop taking LMWH 2-days after restarting Pradaxa; (if eGFR between 30-50, stop Pradaxa ≥ 3-days before procedure; in any patient with rapidly deteriorating renal function -> consult a haematologist).{endif}{endif: trim=left}