Drug | When to stop | When to restart | ||
High-risk procedures | Intermediate-risk procedures | Low-risk procedures | ||
ASA and ASA combinations | Primary prophylaxis: 6 days Secondary prophylaxis: Shared assessment and risk stratification | Shared assessment and risk stratification*¶ | No | 24 hours |
NSAIDs | 5 half-lives | NoΔ | No | 24 hours |
Diclofenac | 1 day | |||
Ketorolac | 1 day | |||
Ibuprofen | 1 day | |||
Etodolac | 2 days | |||
Indomethacin | 2 days | |||
Naproxen | 4 days | |||
Meloxicam | 4 days | |||
Nabumetone | 6 days | |||
Oxaprozin | 10 days | |||
Piroxicam | 10 days | |||
Phosphodiesterase inhibitors | ||||
Cilostazol | 2 days | No | No | 24 hours |
Dipyridamole | 2 days | No | No | |
ASA combinations | Follow ASA recommendations | Shared assessment and risk stratification* | ||
Anticoagulants | ||||
Coumadin | 5 days, normal INR | 5 days, normal INR | No; shared assessment and risk stratification* | 6 hours |
Acenocoumarol | 3 days, normal INR | 3 days, normal INR | No; shared assessment and risk stratification* | 24 hours |
IV heparin | 6 hours | 6 hours | 6 hours | 2 hours◊ |
Subcutaneous heparin, BID, and TID | 24 hours | 6 hours | 6 hours | 2 hours (low-/intermediate-risk procedures) 6 hours (high-risk procedures |
LMWH: Enoxaparin (prophylactic) | 12 hours | 12 hours | 12 hours | 4 hours (low-risk procedures) 12 to 24 hours (medium-/high-risk pain procedures) |
LMWH: Enoxaparin (therapeutic) | 24 hours | 24 hours | 24 hours | 4 hours (low-risk procedures) 12 to 24 hours (intermediate-/high-risk pain procedures) |
LMWH: Dalteparin | 24 hours | 24 hours | 24 hours | 4 hours (low-risk procedures) 12 to 24 hours (intermediate-/high-risk pain procedures) |
Fibrinolytic agents | 48 hours | 48 hours | 48 hours | N/A§ |
Fondaparinux | 4 days | 4 days | Shared assessment and risk stratification | 6 hours (low-/intermediate-risk procedures) 24 hours (high-risk procedures) |
P2Y12 inhibitors | ||||
Clopidogrel | 7 days | 7 days | No; shared assessment and risk stratification | 12 to 24 hours* |
Prasugrel | 7 to 10 days | 7 to 10 days | No; shared assessment and risk stratification | 24 hours |
Ticagrelor | 5 days | 5 days | No; shared assessment and risk stratification | 24 hours |
Cangrelor | 3 hours | 3 hours | Shared assessment and risk stratification | 24 hours |
NOACs | ||||
Dabigatran | 4 days 5 to 6 days (impaired renal function) | 4 days 5 to 6 days (impaired renal function) | Shared assessment and risk stratification* | 24 hours |
Rivaroxaban | 3 days | 3 days | Shared assessment and risk stratification* | 24 hours |
Apixaban | 3 days | 3 days | Shared assessment and risk stratification* | 24 hours |
Edoxaban | 3 days | 3 days | Shared assessment and risk stratification* | 24 hours |
GP IIb/IIIa inhibitors | ||||
Abciximab | 2 to 5 days | 2 to 5 days | 2 to 5 days | 8 to 12 hours |
Eptifibatide | 8 to 24 hours | 8 to 24 hours | 8 to 24 hours | 8 to 12 hours |
Tirofiban | 8 to 24 hours | 8 to 24 hours | 8 to 24 hours | 8 to 12 hours |
Antidepressants and SRIs | Individualized¥ | No | No | Individualized¥ |
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