mid|ine

Interventional Spine
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Aug 2, 2006
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How long is everyone holding xarelto and apixaban? Starting to see a lot of these. We were asking for 5 days on both, but are getting pushback from PCPs and cards. Literature is still minimal.
 

myrandom2003

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We have been doing 24 hours minimum for xarelto. The package insert says 24hours for procedures/surgeries where bleeding is a risk.
 

clubdeac

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Aug 16, 2007
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Steve I like that... however I thought the consensus was 3-5 days for pradaxa depending on renal fxn?
 

Mister Mxyzptlk

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Pradaxa 4 days
Ticlid 14 days
Coumadin 4 days
Eliquis 3 days
Xarelto 2 days

The rest I use the same numbers as Steve, including the baby ASA for Aggrenox.
 

Mister Mxyzptlk

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BTW, how many people have had unacceptable INR after 5 days?
 

pastafan

Interventional Pain Physician
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BTW, how many people have had unacceptable INR after 5 days?
It is unusual but I have had INR>1.4 in patients after 5 days. The record was an elderly woman that did not normalize for over 10 days despite having her increase her PO intake of Vit K foods. She started in therapeutic, not toxic, range. That confirmed my belief in checking INR since it can be measured and I don't want to risk the patient having an avoidable complication.
 
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Mister Mxyzptlk

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I wonder if we shouldn't just give everyone a shot of Vit K the day before.
 

emd123

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Feb 25, 2010
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I wonder if we shouldn't just give everyone a shot of Vit K the day before.
No, because it doesn't work fast to begin with (relies on liver factor production) and makes it much harder to get the INR back up afterwards. A little pre-Pain career experience with Coumadin and giving vitamin K to get inr's down.
 

emd123

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It is unusual but I have had INR>1.4 in patients after 5 days. The record was an elderly woman that did not normalize for over 10 days despite having her increase her PO intake of Vit K foods. She started in therapeutic, not toxic, range. That confirmed my belief in checking INR since it can be measured and I don't want to risk the patient having an avoidable complication.
Not unusual at all since you didn't know where she started. Was the inr 2.2 when you started or 6.2? INR can vary wildly over time in a given patient.