Blood Thinners Guidelines
{note: trim=yes}
{anti_platelet_drug=["Low-dose aspirin", "Clopidogrel (Plavix or Iscover)", "Low-dose aspirin + Clopidogrel (Co-Plavix)", "Dipyridamole (Persantin or Asasantin)"]; trim=yes}
{anti_coagulant_drug=["Warfarin", "Eliquis (Apixaban)", "Xarelto (Rivaroxaban)", "Pradaxa (Dabigatran)"]; trim=yes}
{allmeds=merge(anti_platelet_drug, anti_coagulant_drug); trim=yes}
{endnote: trim=yes}
Do you take ANY Blood-Thinning Medication? {formmenu: name=medstaken; \ ; Yes; No; cols=8; trim=right}
{if: medstaken=="No"}
No Blood-Thinning medication taken.
{elseif: medstaken=="Yes"}
Please choose which medication you are currently taking: {formmenu: name=medication; values={=allmeds}; multiple=yes; cols=35}
{if: medication==[]}{else}Reason for taking an Aspirin preparation (Cartia or Astrix), Clopidogrel (Plavix or Iscover or Co_Plavix) or a Dipyridamole preparation (Persantin or Asasantin): {formmenu: name=anti_platelet_reason; default=Select reason for taking Anti-Platelet Agent; IHD without coronary artery stents; IHD with coronary artery stents inserted over 12 months ago; IHD with coronary artery stents inserted within 12 months; Cerebrovascular disease;Peripheral vascular disease; NO recognised clinical indication for taking this treatment}
{if: medication==[]}{else}Reason for taking Warfarin, Eliquis (Apixaban), Xarelto (Rivaroxaban) or Pradaxa (Dabigatran): {formmenu: name=anti_coagulant_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}
{endif: trim=right}{endif: trim=right}
{if: includes(medication, "Low-dose aspirin")}
For Low-dose aspirin:
{if: anti_platelet_reason == "IHD with coronary artery stents inserted within 12 months"}Do not stop low-dose aspirin before procedure - ONLY omit on day of procedure; restart low-dose aspirin on the next day after procedure.{elseif: anti_platelet_reason == "NO recognised clinical indication for taking this treatment"}Stop low-dose aspirin for 5-days prior procedure; restart low-dose aspirin 7 days after the procedure if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart low-dose aspirin on the next day after procedure.{elseif: includes(["IHD without coronary artery stents", "IHD with coronary artery stents inserted over 12 months ago", "Cerebrovascular disease", "Peripheral vascular disease"], anti_platelet_reason)}Stop low-dose aspirin ONLY for 2-days prior procedure; restart low-dose aspirin on the next day after procedure.
{endif}{endif: trim=right}
{if: includes(medication, "Clopidogrel (Plavix or Iscover)")}
For Clopidogrel (Plavix or Iscover):
{if: anti_platelet_reason == "IHD with coronary artery stents inserted within 12 months"}Discontinue Clopidogrel medication 7 days before the procedure & replace with low-dose aspirin; do not stop low-dose aspirin before procedure - ONLY omit on day of procedure & restart low-dose aspirin on the next day after procedure; restart Clopidogrel medication 7 days after the procedure (and stop low-dose aspirin) if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart Clopidogrel medication on the next day after the procedure (and stop low-dose aspirin).{elseif: anti_platelet_reason == "NO recognised clinical indication for taking this treatment"}Discontinue Clopidogrel medication therapy 7 days before the procedure. Restart Clopidogrel medication 7 days after the procedure if biopsy specimens taken; otherwise if no biopsy specimens are taken restart Clopidogrel medication on the next day after the procedure.{elseif: includes(["IHD without coronary artery stents", "IHD with coronary artery stents inserted over 12 months ago", "Cerebrovascular disease", "Peripheral vascular disease"], anti_platelet_reason)}Discontinue Clopidogrel medication 7 days before the procedure & replace with low-dose aspirin; stop low-dose aspirin 2-days before procedure & restart low-dose aspirin on the next day after procedure; restart Clopidogrel medication 7 days after the procedure (and stop low-dose aspirin) if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart Clopidogrel medication on the next day after the procedure (and stop low-dose aspirin).
{endif}{endif: trim=right}
{if: includes(medication, "Low-dose aspirin + Clopidogrel (Co-Plavix)")}
For Low-dose aspirin + Clopidogrel (Co-Plavix):
{if: anti_platelet_reason == "IHD with coronary artery stents inserted within 12 months"}Liaise with cardiologist about the risk/benefit of discontinuation of one of the anti-platelet agents (discontinue dual anti-platelet therapy for 7 days prior to the procedure & continue with low-dose aspirin alone); omit low-dose aspirin ONLY on day of procedure & restart low-dose aspirin on the next day after procedure; restart dual anti-platelet therapy 7 days after the procedure if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart dual anti-platelet therapy on the next day after the procedure.{elseif: anti_platelet_reason == "NO recognised clinical indication for taking this treatment"}Discontinue dual anti-platelet therapy 7 days prior to the procedure & continue with low-dose aspirin alone; stop low-dose aspirin 2-days before procedure & restart low-dose aspirin on the next day after procedure; restart dual anti-platelet therapy 7 days after the procedure if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart dual anti-platelet therapy on the next day after the procedure.{elseif: includes(["IHD without coronary artery stents", "IHD with coronary artery stents inserted over 12 months ago", "Cerebrovascular disease", "Peripheral vascular disease"], anti_platelet_reason)}Discontinue dual anti-platelet therapy 7 days prior to the procedure & continue with low-dose aspirin alone; omit low-dose aspirin ONLY on day of procedure & restart low-dose aspirin on the next day after procedure; restart dual anti-platelet therapy 7 days after the procedure if specimens taken; otherwise if no biopsy specimens are taken restart dual anti-platelet therapy on the next day after the procedure.
{endif}{endif: trim=right}
{if: includes(medication, "Dipyridamole (Persantin or Asasantin)")}
For Dipyridamole (Persantin or Asasantin):
{if: anti_platelet_reason == "IHD with coronary artery stents inserted within 12 months"}Discontinue Dipyridamole (Persantin or Asasantin) treatment 7 days before the procedure & replace with low-dose aspirin; do not stop low-dose aspirin before procedure - ONLY omit on day of procedure & restart low-dose aspirin on the next day after procedure; restart Dipyridamole (Persantin or Asasantin) treatment 7 days after the procedure (and stop low-dose aspirin) if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart Dipyridamole (Persantin or Asasantin) treatment on the next day after the procedure (and stop low-dose aspirin).{elseif: anti_platelet_reason == "NO recognised clinical indication for taking this treatment"}Discontinue Dipyridamole (Persantin or Asasantin) 5 days before the procedure. Restart Dipyridamole (Persantin or Asasantin) 7 days after the procedure if biopsy specimens taken; otherwise if no biopsy specimens are taken restart Dipyridamole (Persantin or Asasantin) on the next day after the procedure.{elseif: includes(["IHD without coronary artery stents", "IHD with coronary artery stents inserted over 12 months ago", "Cerebrovascular disease", "Peripheral vascular disease"], anti_platelet_reason)}Discontinue Dipyridamole (Persantin or Asasantin) 7 days before the procedure & replace with low-dose aspirin; stop low-dose aspirin 2-days before procedure & restart low-dose aspirin on the next day after procedure; restart Dipyridamole (Persantin or Asasantin) 7 days after the procedure (and stop low-dose aspirin) if biopsy specimens are taken; otherwise if no biopsy specimens are taken restart Dipyridamole (Persantin or Asasantin) on the next day after the procedure (and stop low-dose aspirin).
{endif}{endif: trim=right}
{if: includes(medication, "Warfarin")}
For Warfarin:
{if: includes(["AF without valvular disease", "Xenograft heart valve", "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis"], anti_coagulant_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: 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"], anti_coagulant_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.
{endif}{endif: trim=right}
{if: includes(medication, "Eliquis (Apixaban)")}
For Eliquis (Apixaban):
{if: includes(["AF without valvular disease", "Xenograft heart valve", "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis"], anti_coagulant_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: 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"], anti_coagulant_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.
{endif}{endif: trim=right}
{if: includes(medication, "Xarelto (Rivaroxaban)")}
For Xarelto (Rivaroxaban):
{if: includes(["AF without valvular disease", "Xenograft heart valve", "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis"], anti_coagulant_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: 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"], anti_coagulant_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.
{endif}{endif: trim=right}
{if: includes(medication, "Pradaxa (Dabigatran)")}
For Pradaxa (Dabigatran):
{if: includes(["AF without valvular disease", "Xenograft heart valve", "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis"], anti_coagulant_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: 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"], anti_coagulant_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=right}
{else} This question is mandatory{endif}