Anticoagulation Management for Patients on Eliquis

Perioperative Anticoagulation Management

• Patients on therapeutic-dose Eliquis do not require additional DVT prophylaxis, as they are already anticoagulated, according to the American Society of Anesthesiologists 1, 2
• Bridging anticoagulation is NOT generally required during the 24-48 hour interruption period of Eliquis, as stated by the American College of Cardiology 1, 2
• Once Eliquis is stopped for surgery, patients DO need DVT prophylaxis until therapeutic anticoagulation is restarted, recommends the American Society of Anesthesiologists 1, 2
• Use heparin (UFH or LMWH) or fondaparinux starting at least 6 hours after the procedure, as suggested by the American College of Chest Physicians 1
• Continue prophylactic anticoagulation until surgical hemostasis is established, according to the American Society of Anesthesiologists 1
• Resume therapeutic-dose Eliquis 24-72 hours postoperatively when hemostasis is adequate, recommends the American College of Cardiology 1, 2
• Give the first therapeutic dose 12 hours after the last prophylactic LMWH dose, as stated by the American Society of Anesthesiologists 1

Special Populations

• Hospitalized medical patients on Eliquis for atrial fibrillation do NOT need additional prophylaxis, according to the American College of Chest Physicians 3
• Cancer patients on therapeutic Eliquis for atrial fibrillation or prior VTE are already anticoagulated and do not need additional prophylaxis, as stated by the American Society of Clinical Oncology 5, 6
• Ambulatory cancer patients starting chemotherapy who are already on therapeutic Eliquis do not need additional prophylaxis, recommends the American Society of Clinical Oncology 5, 7

Common Pitfalls to Avoid

• Do not "double anticoagulate": Never add prophylactic-dose anticoagulation to a patient already on therapeutic-dose Eliquis, warns the American Society of Anesthesiologists 1, 2
• Do not perform neuraxial procedures on patients with residual Eliquis levels: Ensure adequate washout time (48 hours minimum, longer if renal impairment) before spinal/epidural anesthesia, as stated by the American Society of Anesthesiologists 1, 2
• Monitor renal function post-operatively: Adjust Eliquis dosing if creatinine clearance changes after surgery, recommends the American College of Cardiology 1
• Avoid overlapping prophylactic and therapeutic anticoagulation: When transitioning from prophylactic LMWH back to therapeutic Eliquis, wait 12 hours after the last LMWH dose, as suggested by the American Society of Anesthesiologists 1