Anticoagulant / Antiplatelet Stoppage For Procedures
Anticoag/Antiplatelet Stoppage
NAV Top A B C D E F H I K L M N O P R S T V W X REF

Anticoagulant / Antiplatelet Stoppage For Procedures
Key Dept. Procedure Type Examples
Anesthesia High-risk Spinal cord stimulation trial and implant, dorsal root ganglion stimulation, intrathecal catheter and pump implant, vertebral augmentation (vertebroplasty and kyphoplasty), percutaneous decompression laminotomy, epiduroscopy and epidural decompression
Intermediate-risk Interlaminar ESIs, transforaminal ESIs, intradiscal procedures, sympathetic blocks (stellate, splanchnic, celiac, lumbar, hypogastric), trigeminal and sphenopalatine ganglia blocks
Low-risk Peripheral nerve blocks, peripheral joints and musculoskeletal injections, trigger point injections including piriformis injection, sacroiliac joint injection and sacral lateral branch blocks, thoracic and lumbar facet MBNB and RFA, peripheral nerve stimulation trial and implant, pocket revision and implantable pulse, generator/intrathecal pump replacement
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 Lung biopsy, Myelo., Epidural Steroid Injections
Paracentesis/Thoracentesis  
Surgery High-risk Procedures No examples provided
Low-risk Procedures No examples provided
A generic (Brand) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 abciximab
(ReoPro)
(not stocked at IHS)		 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)		 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 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		 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		 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)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 bivalirudin
(Angiomax)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 cangrelor
(Kengreal)
(not stocked at IHS)		 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)		 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)		 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)		 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) Dept. Procedure Type
(See Key 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
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)		 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)		 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)		 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)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 edoxaban
(Savaysa)
(not stocked at IHS)		 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		 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		 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)		 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)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
  Feldene - see piroxicam
 fondaparinux
(Arixtra)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 heparin
prophylactic		 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		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 ibuprofen
(Motrin)		 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)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
  Kengreal - see cangrelor
 ketorolac
(Toradol)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
  Lodine - see etodolac
  Lovenox - see enoxaparin
M generic (Brand) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 meloxicam
(Mobic)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 nabumetone
(Relafen)		 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)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 oxaprozin
(Daypro)
(not stocked at IHS)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 pentosan polysulfate sodium
(Elmiron)		 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)		 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)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
  Relafen - see nabumetone
  ReoPro - see abciximab
 rivaroxaban
(Xarelto)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
  Savaysa - see edoxaban
T generic (Brand) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 ticagrelor
(Brilinta)		 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)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
  Voltaren - see diclofenac
W generic (Brand) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
 warfarin
(Coumadin)		 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) Dept. Procedure Type
(See Key for examples)		 Stop Medication Prior To Procedure Restart after:
  Xarelto - see rivaroxaban
last updated: 11/10/2022
 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.
Periprocedural Guidelines for Anticoagulant and Antiplatelet Agents
Pharmacists Letter - Antithrombotic Management in Regional Anesthesia

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