Holding DOAC Before Endoscopy

*******************PRADAXA******************************

A Cardiology E-Consultation was submitted on _______ for:

        -GI Requesting Cardiology input on holding anticoagulation prior to

         endoscopy

IMPRESSION:

1.  Paroxysmal / Persistent / Permanent Atrial Fibrillation

        -CHADS2-VASc = _____

2.  Planned Endoscopy

        -Endoscopy is characterized as a low risk bleeding procedure, with a 2

         day risk of major bleed 0-2% (Spyropoulos AC, Douketis JD. How I

         treat anticoagulated patients undergoing an elective procedure or

         surgery. Blood 2012; 120:2954)

RECOMMENDATIONS:

1.  Please calculate the patient's CrCl (by Cockcroft-Gault)

        -If CrCl (by Cockcroft-Gault) > 50 mL/min, recommend Pradaxa be omitted

         for one day prior to endoscopy and can be restarted one day afterwards.

        -If CrCl (by Cockcroft-Gault) = 30-50 mL/min, Pradaxa can be omitted for

         two days prior to endoscopy and ce be restarted one day afterards

If any questions or concerns, please place new cardiology E-consultation.  Thank you

*************************XARELTO*****************************

A Cardiology E-Consultation was submitted on ______ for:

        -GI Requesting Cardiology input on holding anticoagulation prior to

         endoscopy

IMPRESSION:

1.  Paroxysmal / Persistent / Permanent Atrial Fibrillation

        -CHADS2-VASc = _____

2.  Planned Endoscopy

        -Endoscopy is characterized as a low risk bleeding procedure, with a 2

         day risk of major bleed 0-2% (Spyropoulos AC, Douketis JD. How I

         treat anticoagulated patients undergoing an elective procedure or

         surgery. Blood 2012; 120:2954)

RECOMMENDATIONS:

1.  Please calculate the patient's CrCl (by Cockcroft-Gault)

2.  If CrCl (by Cockcroft-Gault) > 30 mL/min, recommend Xarelto be omitted for

    one day prior to endoscopy and can be restarted one day afterwards.

If any questions or concerns, please place new cardiology E-consultation.  Thank you

*************************APIXIBAN*****************************

A Cardiology E-Consultation was submitted on ______ for:

        -GI Requesting Cardiology input on holding anticoagulation prior to

         endoscopy

IMPRESSION:

1.  Paroxysmal / Persistent / Permanent Atrial Fibrillation

        -CHADS2-VASc = _____

2.  Planned Endoscopy

        -Endoscopy is characterized as a low risk bleeding procedure, with a 2

         day risk of major bleed 0-2% (Spyropoulos AC, Douketis JD. How I

         treat anticoagulated patients undergoing an elective procedure or

         surgery. Blood 2012; 120:2954)

RECOMMENDATIONS:

1.  Please calculate the patient's CrCl (by Cockcroft-Gault)

2.  If CrCl (by Cockcroft-Gault) > 30 mL/min, recommend Apixiban be omitted

    for one day prior to endoscopy and can be restarted one day afterwards.