{note: trim=right}
{reasonslist=["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", "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"]}
{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 medication: {formmenu: name=reasons; values={=reasonslist}; multiple=yes}
{endif: trim=left}
{if: includes(medication, "Low-dose aspirin")}
For Low-dose aspirin:
{if: includes(reasons, "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: includes(reasons, "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(reasons, "IHD without coronary artery stents") or includes(reasons, "IHD with coronary artery stents inserted over 12 months ago") or includes(reasons, "Cerebrovascular disease") or includes(reasons, "Peripheral vascular disease")}Stop low-dose aspirin ONLY for 2-days prior procedure; restart low-dose aspirin on the next day after procedure.
{endif: trim=left}{endif: trim=right}
{if: includes(medication, "Clopidogrel (Plavix or Iscover)")}
For Clopidogrel (Plavix or Iscover):
{if: includes(reasons, "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: includes(reasons, "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(reasons, "IHD without coronary artery stents") or includes(reasons, "IHD with coronary artery stents inserted over 12 months ago") or includes(reasons, "Cerebrovascular disease") or includes(reasons, "Peripheral vascular disease")}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: trim=left}{endif: trim=right}
{if: includes(medication, "Low-dose aspirin + Clopidogrel (Co-Plavix)")}
For Low-dose aspirin + Clopidogrel (Co-Plavix):
{if: includes(reasons, "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: includes(reasons, "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(reasons, "IHD without coronary artery stents") or includes(reasons, "IHD with coronary artery stents inserted over 12 months ago") or includes(reasons, "Cerebrovascular disease") or includes(reasons, "Peripheral vascular disease")}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: trim=left}{endif: trim=right}
{if: includes(medication, "Dipyridamole (Persantin or Asasantin)")}
For Dipyridamole (Persantin or Asasantin):
{if: includes(reasons, "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: includes(reasons, "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(reasons, "IHD without coronary artery stents") or includes(reasons, "IHD with coronary artery stents inserted over 12 months ago") or includes(reasons, "Cerebrovascular disease") or includes(reasons, "Peripheral vascular disease")}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: trim=left}{endif: trim=right}
{if: includes(medication, "Warfarin")}
For Warfarin:
{if: includes(reasons, "AF without valvular disease") or includes(reasons, "Xenograft heart valve") or includes(reasons, "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis")}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"], reasons)}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: trim=left}{endif: trim=right}
{if: includes(medication, "Eliquis (Apixaban)")}
For Eliquis (Apixaban):
{if: includes(reasons, "AF without valvular disease") or includes(reasons, "Xenograft heart valve") or includes(reasons, "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis")}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(reasons, "AF and mitral stenosis") or includes(reasons, "Prosthetic metal heart valve and AF") or includes(reasons, "Prosthetic metal heart valve in mitral position") or includes(reasons, "Prosthetic metal heart valve in aortic position") or includes(reasons, "Less than 6-months after Pulmonary Embolism or Deep Venous Thrombosis") or includes(reasons, "Thrombophilia syndromes")}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: trim=left}{endif: trim=right}
{if: includes(medication, "Xarelto (Rivaroxaban)")}
For Xarelto (Rivaroxaban):
{if: includes(reasons, "AF without valvular disease") or includes(reasons, "Xenograft heart valve") or includes(reasons, "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis")}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(reasons, "AF and mitral stenosis") or includes(reasons, "Prosthetic metal heart valve and AF") or includes(reasons, "Prosthetic metal heart valve in mitral position") or includes(reasons, "Prosthetic metal heart valve in aortic position") or includes(reasons, "Less than 6-months after Pulmonary Embolism or Deep Venous Thrombosis") or includes(reasons, "Thrombophilia syndromes")}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: trim=left}{endif: trim=right}
{if: includes(medication, "Pradaxa (Dabigatran)")}
For Pradaxa (Dabigatran):
{if: includes(reasons, "AF without valvular disease") or includes(reasons, "Xenograft heart valve") or includes(reasons, "Greater than 6-months after Pulmonary Embolism or Deep Venous Thrombosis")}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(reasons, "AF and mitral stenosis") or includes(reasons, "Prosthetic metal heart valve and AF") or includes(reasons, "Prosthetic metal heart valve in mitral position") or includes(reasons, "Prosthetic metal heart valve in aortic position") or includes(reasons, "Less than 6-months after Pulmonary Embolism or Deep Venous Thrombosis") or includes(reasons, "Thrombophilia syndromes")}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: trim=left}{endif: trim=right}
{else: trim=left} This question is mandatory{endif: trim=left}