Anticoagulants (blood thinners)

Patients taking anticoagulants (blood thinners) have to stop them before any invasive procedures. The concern is uncontrolled bleeding. This must be discussed with your doctor prior to having any invasive procedure. Myelogram is an invasive procedure.

EXAMPLES OF PRESCRIPTION BLOOD THINNERS INCLUDE: • Coumadin (warfarin), Jantoven (warfarin) • Antiplatelet drugs: Agrylin (Anagrelide), Plavix (clopidogrel), Ticlid (ticlopidine), Dipyridamole (Aggrenox, Persantine), Pentoxyphylline (Trental), Cilostazol (Pletal), Effient (prasugrel), Brilinta (Ticagrelor) • Heparin Anticoagulants: Lovenox (enoxaparin, LMWH), Heparin (unfractionated), Fragmin (Dalteparin) • Other Anticoagulants: Xarelto (rivaroxaban), Pradaxa (dabigatran), Eliquis (apixaban), Arixtra (fondaparinux)

EXAMPLES OF OVER THE COUNTER BLOOD THINNER MEDICATIONS: • NSAID's : Aspirin (Ecotrin, some forms of Exedrin) Diclofenac (Voltaren, Arthrotec), Ibuprofen (Motrin, Advil), Naproxen (Naprosyn, Aleve, Anaprox) Celecoxib (Celebrex), Etodolac (Lodine), Nabumetone (Relafen), Indomethacin (Indocin), Oxaprozin (Daypro), Piroxicam (Feldene), Meloxicam (Mobic), Diflunisal (Dolobid) *Tylenol is not a blood thinner. It is safe to use when off your blood thinners. • Nutritional and Herbal supplements: Echinacea, Garlic, Gingko Biloba, Goldenseal, Dong quai, Feverfew, Fish Oil (Omega III), Ginseng, St. John’s wort, and valerian root

SURGERY / INVASIVE PROCEDURES / EGD / COLONOSCOPY A. STOP Coumadin, for at least 5 full days before your procedure. STOP ALL Antiplatelet Drugs, for at least 7 full days before your procedure STOP Heparin Anticoagulants, for at least 24hrs before your procedure STOP All Other Anticoagulants Drugs, for at least 2 full days (if have renal disease/failure 5 days) STOP ALL NSAID's, Herbals for 7 full days before your procedure. B. RESTART Must Speak with you surgeon about when to restart your anticoagulation medications. C. WHILE off of your Blood Thinner(s), you may need to be on a different blood thinner to protect you during this time. It is very important to inform your doctor you take these medications so he/she can determine if another medication is required during the period you are not on your regular blood thinner.

What TO DO Drug to STOP: ______ON Date: ______Restart on Date: ______PT/INR lab date: ______(in AM) Fax result to 913-322-7410 Drug to START: ______ON Date: ______Stop on Date: ______

If you have not discussed with your surgeon when to stop your blood thinner medication or if you have to start another, call immediately.