When should I stop Mounjaron (anticoagulant) in a patient?

When to Stop Mounjaron (Anticoagulant) in a Patient

Mounjaron (anticoagulant) should be stopped 48-72 hours before high bleeding risk procedures and 24 hours before low bleeding risk procedures, with timing adjusted based on renal function and the specific bleeding risk of the procedure. 1

General Principles for Anticoagulation Discontinuation

• Anticoagulation should be stopped 2-4 days before invasive procedures when bleeding risk is significant, with specific timing based on the type of anticoagulant and patient factors 1
• The decision to stop anticoagulation must balance the risk of thromboembolism against the risk of bleeding during the procedure 2, 1
• For low bleeding risk procedures (dental work, cataract surgery, minor skin procedures), anticoagulation can often be continued without interruption 1, 2

Specific Timing for Anticoagulation Discontinuation

High Bleeding Risk Procedures

• For high bleeding risk procedures, stop Mounjaron:
  • 48 hours before the procedure if patient has normal renal function (CrCl ≥80 mL/min) 2, 1
  • 72 hours before the procedure if patient has moderate renal impairment (CrCl 50-79 mL/min) 2
  • 96 hours before the procedure if patient has severe renal impairment (CrCl 30-49 mL/min) 2

Low Bleeding Risk Procedures

• For low bleeding risk procedures, stop Mounjaron:
  • 24 hours before the procedure if patient has normal renal function 2, 1
  • 36 hours before the procedure if patient has moderate renal impairment 2
  • 48 hours before the procedure if patient has severe renal impairment 2

Stopping Anticoagulation for Bleeding Events

• For major bleeding events, immediately discontinue Mounjaron and consider reversal agents if available 2
• For non-major bleeding, temporarily discontinue Mounjaron until hemostasis is achieved and bleeding risk is resolved 2
• When a patient develops a gastrointestinal bleed while on anticoagulation, stop the anticoagulant until adequate hemostasis has been achieved 2

Restarting Anticoagulation After Stopping

• Resume full dose of anticoagulation ≥24 hours after low bleeding risk procedures 2
• Resume full dose of anticoagulation 48-72 hours after high bleeding risk procedures 2
• After bleeding events, early resumption of anticoagulation (without bridging therapy) is recommended once hemostasis has been achieved 2

Special Considerations

• For patients with mechanical heart valves or high thrombotic risk, consider bridging with heparin when the anticoagulant is discontinued 2, 1
• For patients with atrial fibrillation undergoing coronary stenting who develop bleeding on triple therapy (dual antiplatelet therapy plus anticoagulant), consider stopping one antiplatelet agent 2
• For emergency procedures, consider specific reversal agents if available for the particular anticoagulant 2

Common Pitfalls to Avoid

• Avoid stopping anticoagulation for low bleeding risk procedures unnecessarily, as this increases thrombotic risk 1, 2
• Don't restart anticoagulation too early after high bleeding risk procedures (wait at least 48-72 hours) 2
• Avoid restarting anticoagulation before adequate hemostasis is achieved after a bleeding event 2
• Don't forget to consider patient-specific factors like renal function when determining timing for stopping anticoagulation 2