Assess continuing indication for OAC Evaluate risks benefits w multidisciplinary team and shared decision making

By rray, 25 March, 2024
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Address modifiable bleeding risk factors Check for meds that interfere w OAC levels
If low thromboembolic risk AF w CHA2DS2 VASc 3mo prior bioprosthetic valve w o AF 3mo ago discontinuing OAC is reasonable
If major GI bleed and reversible causes corrected resuming OAC may be reasonable B NR Consider delayed restart
If ICH in pt w AF and 5 yr risk of thromboembolic events rheumatic heart dz mech heart valve hx of stroke VTE active malignancy genetic thrombophilia CHA2DS2 VASc score 5 early resumption of OAC is reasonable to reduce thromboembolic events C LD Consider
If ICH and high risk of recurrence cerebral amyloid angiopathy lobar intraparenchymal hemorrhage older age 10 microbleeds on MRI disseminated cortical superficial siderosis on MRI poorly controlled HTN hx of spontaneous ICH genetic acquired coagulopathy u
If NPO awaiting invasive procedure pregnancy high risk of rebleed being bridged back to warfarin w high thrombotic risk suggest temporary or long term parenteral anticoagulation
If on antiplatelet tx assess need for aspirin in stable CAD or ACS reassess need for DAPT in pts after PCI and consider d c of aspirin
If reversible cause related to OAC e g high INR change in renal fxn interacting meds consider switching OAC
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Assess continuing indication for OAC. Evaluate risks/benefits w/ multidisciplinary team and shared decision-making.