By rray, 25 January, 2024 If pregnant DOACs not recommended Warfarin safe in all trimesters If warfarin dose 5 mg day use LMWH Stop anticoagulation 36h before planned delivery
By rray, 25 January, 2024 If stage 3 or 4 CKD w elevated stroke risk prescribe warfarin or DOAC dose adjusted for CrCl
By rray, 25 January, 2024 If PAD anticoagulant monotherapy preferred over combo tx w aspirin P2Y12 inhibitors
By rray, 25 January, 2024 If 1y post PCI or CAD w o coronary revasc OAC monotherapy preferred over combo tx w aspirin P2Y12 inhibitors
By rray, 25 January, 2024 If ACS or PCI DOAC antiplatelet preferred over warfarin If PCI d c aspirin early 1 4wk and continue DOAC P2Y12 inhibitor vs triple tx to reduce bleed risk
By rray, 25 January, 2024 If using warfarin target INR 2 3 consistent vit K dietary intake and routine INR monitoring
By rray, 25 January, 2024 DOAC options nbsp nbsp Direct thrombin inhibitor dabigatran nbsp nbsp Factor Xa inhibitors rivaroxaban apixaban edoxaban nbsp nbsp If liver dz Child Pugh Class B Avoid rivaroxaban
By rray, 25 January, 2024 Consider drug interactions when prescribing warfarin and DOACs esp CYP3A4 and or p glycoprotein inhibitors or inducers May require altered dosing
By rray, 25 January, 2024 If post bariatric surgery warfarin 1st line due to concerns about DOAC absorption