Note: Clinical trial evaluating safety and efficacy utilized the Cockcroft-Gault formula with the use of actual body weight (data on file; Boehringer Ingelheim Pharmaceuticals Inc 2012).
High Alert Drug: direct thrombin inhibitors
• Nurses and pharmacists verify dose and that patient is not on another anticoagulant prior to administration. • Two RNs independently verify dose prior to administration if the dosing requires manipulation (i.e. drawing up a portion of a vial, or giving a portion of a syringe}. • Anticoagulation comparison chart available on nursing units for reference. • Pharmacists/nurses provide patient education for oral anticoagulants. • Pharmacists monitor for appropriate dosing, labs, and prevention of adverse events. • Reversal agents and order sets for oral anticoagulants
Anticoagulant / Antiplatelet Stoppage For Procedures
generic (Brand)
Dept.
Procedure Type (hover over entry for examples)
Stop Medication Prior To Procedure Restart after:
dabigatran (Pradaxa)
Anesthesia
High-risk
4 days (5-6 days impaired renal function) Restart after 24 hours
Intermediate-risk
4 days (5-6 days impaired renal function) Restart after 24 hours
Low-risk
Requires shared assessment and risk stratification Restart after 24 hours
Patients with high risk of bleeding (eg, old age, history of bleeding tendency, concurrent uses of other anticoagulants/antiplatelets, liver cirrhosis or advanced liver disease, and advanced renal disease) undergoing low- or intermediate-risk procedures should be treated as intermediate or high risk, respectively.
Radiology
Invasive Procedures
3 days (Hold time may need to by extended with impaired renal function)
Paracentesis/Thoracentesis
24 hours (Hold time may need to be extended with impaired renal function)
Surgery
High-risk
CrCl > 50 mL/min - 3 days CrCl 30-50 mL/min - 5 days Restart after 2-3 days
Low-risk
CrCl > 50 mL/min - 3 days CrCl 30-50 mL/min - 5 days Restart after 2-3 days
Enteral Drug Administration notes.
Generic (Brand)
Comments and Considerations
Recommendations for Administration with Enteral Nutrition
dabigatran (Pradaxa)
Capsules should not be broken or opened.
Suggest using another form of anticoagulation until patient is able to take capsule whole.
• Two RNs independently verify dose prior to administration if the dosing requires manipulation (i.e. drawing up a portion of a vial, or giving a portion of a syringe}.
• Anticoagulation comparison chart available on nursing units for reference.
• Pharmacists/nurses provide patient education for oral anticoagulants.
• Pharmacists monitor for appropriate dosing, labs, and prevention of adverse events.
• Reversal agents and order sets for oral anticoagulants
(hover over entry for examples)
(Pradaxa)
CrCl 30-50 mL/min - 5 days Restart after 2-3 days
CrCl 30-50 mL/min - 5 days Restart after 2-3 days
(Brand)
(Pradaxa)