Peri-Procedure Bridgingwith Enoxaparin

Pre-procedure

• Stop warfarin:

  • 5 d prior if INR = 2-3
  • 6 d prior if INR = 3-4.5

• Start enoxaparin:

  • 1 mg/kg q12h 36 h after warfarin stopped

• Stop enoxaparin:

  • 12-18 h prior procedure
  • Mean: 13.5 h

Post-procedure

• Restart enoxaparin:

  • 1 mg/kg q12 once hemostasis established

• Restart warfarin:

  • At previous dose after procedure

• Stop enoxaparin:

  • Once INR is therapeutic

Spandorfer, et. al. Am J Card 1999; 84: 478-480

Bridging Protocol

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