By rray, 26 January, 2024 Exclude Patient Type Detail Header No Detail Type Text Detail Text Aspirin alone or w clopidogrel not recommended as alternative to anticoagulation If mitral stenosis or mech heart valve warfarin 1st line DOACs 1st line for other valve dz If post bariatric surgery warfarin 1st line due to concerns about DOAC absorption If hx active CA DOACs 1st line Consider drug interactions when prescribing warfarin and DOACs esp CYP3A4 and or p glycoprotein inhibitors or inducers May require altered dosing 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 If using warfarin target INR 2 3 consistent vit K dietary intake and routine INR monitoring 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 If 1y post PCI or CAD w o coronary revasc OAC monotherapy preferred over combo tx w aspirin P2Y12 inhibitors If PAD anticoagulant monotherapy preferred over combo tx w aspirin P2Y12 inhibitors If stage 3 or 4 CKD w elevated stroke risk prescribe warfarin or DOAC dose adjusted for CrCl If ESRD CrCl If pregnant DOACs not recommended Warfarin safe in all trimesters If warfarin dose 5 mg day use LMWH Stop anticoagulation 36h before planned delivery Patient Type Detail Header (Long) If anticoagulation is appropriate, DOACs preferred.
