From the Research
For a right and left heart catheterization procedure, anticoagulants do not necessarily need to be held, as the procedure can be safely performed in fully anticoagulated patients using a transradial technique with a low bleeding and thromboembolic risk. The decision to hold anticoagulants should be based on individual patient factors, such as the risk of thrombosis and the urgency of the procedure. According to a study published in the Journal of interventional cardiology 1, left and right heart catheterization can be safely performed in most fully anticoagulated patients using a transradial technique with a low bleeding and thromboembolic risk.
Some key points to consider when deciding whether to hold anticoagulants include:
- The patient's individual risk of thrombosis and bleeding
- The urgency of the procedure
- The use of a transradial technique, which may reduce the risk of bleeding
- The patient's renal function, which may affect the clearance of anticoagulants
It's also important to note that the timing of anticoagulant resumption after the procedure depends on hemostasis at the access site, usually 4-6 hours for heparin and 24 hours for oral anticoagulants, as suggested by a study published in the Journal of invasive cardiology 2. However, the most recent and highest quality study on this topic, published in 2024 in The American journal of medicine 3, does not provide specific guidance on the holding of anticoagulants prior to right and left heart catheterization.
In terms of specific anticoagulants, the following general guidelines may be considered:
- Warfarin (Coumadin) may not need to be discontinued, as the procedure can be safely performed in fully anticoagulated patients
- Direct oral anticoagulants (DOACs) like apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa), and dabigatran (Pradaxa) may not need to be held, but this decision should be based on individual patient factors
- Low molecular weight heparins (LMWHs) like enoxaparin (Lovenox) and unfractionated heparin may not need to be discontinued, but this decision should be based on individual patient factors
Ultimately, the decision to hold anticoagulants prior to right and left heart catheterization should be made on a case-by-case basis, taking into account the individual patient's risk factors and the specifics of the procedure.