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LOW risk for bleeding
LOW risk for bleeding
Withholding
Withholding
Target INR ≤ 3
Consider bridging to heparin for high thrombosis risk cases
Reinitiation
Reinitiation
Usually not applicable
Same day re-initiation for bridged patients
HIGH risk for bleeding
HIGH risk for bleeding
Withholding
Withholding
5 days until target INR ≤ 1.8
Consider bridging to heparin for high thrombosis risk cases
if STAT or emergent case, use reversal agent (Vitamin K, FFP)
Reinitiation
Reinitiation
Day after procedure
High thrombosis risk cases may benefit from bridging with LMWH and multidisciplinary management especially if reversal agent used along with vitamin K
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