A
generic (Brand)
abciximab (ReoPro) (not stocked at IHS)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
2-5 days Restart after 8-12 hours
Intermediate-risk
2-5 days Restart after 8-12 hours
Low-risk
2-5 days Restart after 8-12 hours
Radiology
Invasive Procedures
No data
Paracentesis/Thoracentesis
No data
Surgery
High-risk
No data Restart after No data
Low-risk
No data Restart after No data
Aggrastat - see tirofiban
Aggrenox - see aspirin-dipyridamole
Angiomax - see bivalirudin
apixaban (Eliquis)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
3 days Restart after 24 hours
Intermediate-risk
3 days Restart after 24 hours
Low-risk
Requires shared assessment and risk stratification Restart after 24 hours
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
5 doses Restart after 2-3 days
Low-risk
2 days Restart after 2-3 days
argatroban
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
No data Restart after No data
Intermediate-risk
No data Restart after No data
Low-risk
No data Restart after No data
Radiology
Invasive Procedures
8 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
No data Restart after No data
Low-risk
No data Restart after No data
Arixtra - see fondaparinux
aspirin 325 mg
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
Primary prophylaxis: 6 days; Secondary prophylaxis: Shared assessment and risk stratification Restart after 24 hours
Intermediate-risk
Requires shared assessment and risk stratification Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
7 days
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
aspirin 81 mg
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
Primary prophylaxis: 6 days; Secondary prophylaxis: Shared assessment and risk stratification Restart after 24 hours
Intermediate-risk
Requires shared assessment and risk stratification Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
3 days
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
aspirin-dipyridamole (Aggrenox)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
Primary prophylaxis: 6 days; Secondary prophylaxis: Shared assessment and risk stratification Restart after 24 hours
Intermediate-risk
Requires shared assessment and risk stratification Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
7 days
Paracentesis/Thoracentesis
48 hours
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
B
generic (Brand)
bivalirudin (Angiomax)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
No data Restart after No data
Intermediate-risk
No data Restart after No data
Low-risk
No data Restart after No data
Radiology
Invasive Procedures
8 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
No data Restart after No data
Low-risk
No data Restart after No data
Brilinta - see ticagrelor
C
generic (Brand)
cangrelor (Kengreal) (not stocked at IHS)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
3 hours Restart after 24 hours
Intermediate-risk
3 hours Restart after 24 hours
Low-risk
Requires shared assessment and risk stratification Restart after 24 hours
Radiology
Invasive Procedures
No data
Paracentesis/Thoracentesis
No data
Surgery
High-risk
Requires shared assessment and risk stratification Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
celecoxib (CeleBREX)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
24 hours Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
24 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
cilostazol (Pletal)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
48 hours Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
3 days
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
clopidogrel (Plavix)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
7 days Restart after 12 (if usual dose); 24 hours (if loading dose used)
Intermediate-risk
7 days Restart after 12 (if usual dose); 24 hours (if loading dose used)
Low-risk
Requires shared assessment and risk stratification Restart after 12 (if usual dose); 24 hours (if loading dose used)
Radiology
Invasive Procedures
7 days
Paracentesis/Thoracentesis
5 days
Surgery
High-risk
5 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
Coumadin - see warfarin
D
generic (Brand)
dabigatran (Pradaxa)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
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
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
dalteparin (Fragmin) (not stocked at IHS)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
24 hours Restart after 12-24 hours
Intermediate-risk
24 hours Restart after 12-24 hours
Low-risk
24 hours Restart after 4 hours
Radiology
Invasive Procedures
24 hours
Paracentesis/Thoracentesis
12 hours
Surgery
High-risk
24 hours Restart after No data
Low-risk
24 hours Restart after No data
Daypro - see oxaprozin
desirudin (Iprivask) (not stocked at IHS)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
No data Restart after No data
Intermediate-risk
No data Restart after No data
Low-risk
No data Restart after No data
Radiology
Invasive Procedures
8 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
No data Restart after No data
Low-risk
No data Restart after No data
diclofenac (Voltaren) (not stocked at IHS)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
24 hours Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
24 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
dipyridamole (Persantine)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
48 hours Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
7 days
Paracentesis/Thoracentesis
48 hours
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
E
generic (Brand)
edoxaban (Savaysa) (not stocked at IHS)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
3 days Restart after 24 hours
Intermediate-risk
3 days Restart after 24 hours
Low-risk
Requires shared assessment and risk stratification Restart after 24 hours
Radiology
Invasive Procedures
3 days (Hold time may need to be extended with impaired renal function)
Paracentesis/Thoracentesis
24 hours (Hold time may need to be extended with impaired renal function)
Surgery
High-risk
4 doses Restart after 2-3 days
Low-risk
2 days Restart after 2-3 days
Effient - see prasugrel
Eliquis - see apixaban
Elmiron - see pentosan polysulfate sodium
enoxaparin (Lovenox) prophylactic
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
12 hours Restart after 12-24 hours
Intermediate-risk
12 hours Restart after 12-24 hours
Low-risk
12 hours Restart after 4 hours
Radiology
Invasive Procedures
3 days
Paracentesis/Thoracentesis
12 hours
Surgery
High-risk
24 hours Restart after 48-72 hours
Low-risk
24 hours Restart after 24 hours
enoxaparin (Lovenox) therapeutic
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
24 hours Restart after 12-24 hours
Intermediate-risk
24 hours Restart after 12-24 hours
Low-risk
24 hours Restart after 4 hours
Radiology
Invasive Procedures
3 days
Paracentesis/Thoracentesis
12 hours
Surgery
High-risk
24 hours Restart after 48-72 hours
Low-risk
24 hours Restart after 24 hours
eptfibatide (Integrilin) (not stocked at IHS)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
8-24 hours Restart after 8-12 hours
Intermediate-risk
8-24 hours Restart after 8-12 hours
Low-risk
8-24 hours Restart after 8-12 hours
Radiology
Invasive Procedures
No data
Paracentesis/Thoracentesis
No data
Surgery
High-risk
No data Restart after No data
Low-risk
No data Restart after No data
etodolac (Lodine) (not stocked at IHS)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
48 hours Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
24 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
F
generic (Brand)
Feldene - see piroxicam
fondaparinux (Arixtra)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
4 days Restart after 24 hours
Intermediate-risk
4 days Restart after 24 hours
Low-risk
Requires shared assessment and risk stratification Restart after 6 hours
Radiology
Invasive Procedures
3 days
Paracentesis/Thoracentesis
24 hours
Surgery
High-risk
4 days Restart after 24 hours
Low-risk
4 days Restart after 24 hours
Fragmin - see dalteparin
H
generic (Brand)
heparin prophylactic
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
24 hours Restart after 6-8 hours
Intermediate-risk
6 hours Restart after 6-8 hours
Low-risk
6 hours Restart after 2 hours
Radiology
Invasive Procedures
6 hours
Paracentesis/Thoracentesis
6 hours
Surgery
High-risk
6 hours Restart after 48-72 hours
Low-risk
4 hours Restart after 24 hours
heparin therapeutic
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
6 hours Restart after 24 hours
Intermediate-risk
6 hours Restart after 24 hours
Low-risk
6 hours Restart after 2 hours
Radiology
Invasive Procedures
6 hours
Paracentesis/Thoracentesis
6 hours
Surgery
High-risk
6 hours Restart after 48-72 hours
Low-risk
4 hours Restart after 24 hours
I
generic (Brand)
ibuprofen (Motrin)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
24 hours Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
24 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
indomethacin (Indocin)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
48 hours Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
24 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
Integrilin - see eptfibatide
Iprivask - see desirudin
K
generic (Brand)
Kengreal - see cangrelor
ketorolac (Toradol)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
24 hours Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
24 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
L
generic (Brand)
Lodine - see etodolac
Lovenox - see enoxaparin
M
generic (Brand)
meloxicam (Mobic)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
4 days Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
48-72 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
Mobic - see meloxicam
Motrin - see ibuprofen
N
generic (Brand)
nabumetone (Relafen)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
6 days Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
48-72 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
naproxen (Naprosyn)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
4 days Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
48-72 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
O
generic (Brand)
oxaprozin (Daypro) (not stocked at IHS)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
10 days Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
48-72 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
P
generic (Brand)
pentosan polysulfate sodium (Elmiron)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
5 days Restart after 24 hours
Intermediate-risk
5 days Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
3 days
Paracentesis/Thoracentesis
3 days
Surgery
High-risk
24-72 hours Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
Persantine - see dipyridamole
piroxicam (Feldene) (not stocked at IHS)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
10 days Restart after 24 hours
Intermediate-risk
No hold Restart after 24 hours
Low-risk
No hold Restart after 24 hours
Radiology
Invasive Procedures
48-72 hours
Paracentesis/Thoracentesis
No hold
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
Plavix - see clopidogrel
Pletal - see cilostazol
Pradaxa - see dibigatran
prasugrel (Effient)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
7-10 days Restart after 24 hours
Intermediate-risk
7-10 days Restart after 24 hours
Low-risk
Requires shared assessment and risk stratification Restart after 24 hours
Radiology
Invasive Procedures
7 days
Paracentesis/Thoracentesis
5 days
Surgery
High-risk
7 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
R
generic (Brand)
Relafen - see nabumetone
ReoPro - see abciximab
rivaroxaban (Xarelto)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
3 days Restart after 24 hours
Intermediate-risk
3 days Restart after 24 hours
Low-risk
Requires shared assessment and risk stratification Restart after 24 hours
Radiology
Invasive Procedures
3 days (Hold time may need to be extended with impaired renal function)
Paracentesis/Thoracentesis
24 hours (Hold time may need to be extended with impaired renal function)
Surgery
High-risk
4 doses Restart after 2-3 days
Low-risk
2 days Restart after 2-3 days
S
generic (Brand)
Savaysa - see edoxaban
T
generic (Brand)
ticagrelor (Brilinta)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
5 days Restart after 24 hours
Intermediate-risk
5 days Restart after 24 hours
Low-risk
Requires shared assessment and risk stratification Restart after 24 hours
Radiology
Invasive Procedures
7 days
Paracentesis/Thoracentesis
5 days
Surgery
High-risk
5 days Restart after 24 hours
Low-risk
No Hold Restart after 24 hours
tirofiban (Aggrastat)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
8-24 hours Restart after 8-12 hours
Intermediate-risk
8-24 hours Restart after 8-12 hours
Low-risk
8-24 hours Restart after 8-12 hours
Radiology
Invasive Procedures
No data
Paracentesis/Thoracentesis
No data
Surgery
High-risk
No data Restart after No data
Low-risk
No data Restart after No data
Toradol - see ketorolac
V
generic (Brand)
Voltaren - see diclofenac
W
generic (Brand)
warfarin (Coumadin)
Dept.
Procedure Type(See Key for examples)
Stop Medication Prior To Procedure Restart after:
Anesthesia
High-risk
5 days Restart after 6 hours
Intermediate-risk
normal INR ( ≤ 1.2) Restart after 6 hours
Low-risk
5 days Restart after 6 hours
Radiology
Invasive Procedures
7 days
Paracentesis/Thoracentesis
5 days
Surgery
High-risk
5 days, INR < 1.4 Restart after 12-24 hours
Low-risk
5 days, INR < 1.4 Restart after 12-24 hours
Bridging anticoagulation may be appropriate in patients who will have a very high thromboembolic risk with prolonged interruption of their anticoagulant, such as warfarin.
X
generic (Brand)
Xarelto - see rivaroxaban
References
Narouze S, Benzon HT, Provenzano D, Buvanendran A, Andres JD, Deer T, Rauck R, Huntoon MA. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2018; 43(3):225-262.
Jaffe TA, Raiff D, Ho LM, Kim CY. Management of Anticoagulant and Antiplatelet Medications in Adults Undergoing Percutaneous Interventions. American Journal of Roentgenology. 2015; 205:421-428.
Policy Periprocedural Guidelines for Anticoagulant and Antiplatelet Agents
View Pharmacists Letter - Antithrombotic Management in Regional Anesthesia