Periprocedural Management of Antithrombotic Therapy – Adult - Inpatient/Ambulatory Consensus Care Guideline Appendix A. Examples of Warfarin Bridging with Enoxaparin Assumptions: • Warfarin is being taken in the evening and is being held x 5 days prior to an outpatient procedure • The patient has been deemed high risk for TE complications • The patient’s CrCl > 30 mL/min • Enoxaparin dose = 1 mg/kg SQ every 12 hours, rounded to nearest commercially available strength Low/Moderate Bleed Risk Procedure Example Bridge Plan Date Enoxaparin AM Enoxaparin PM Warfarin Notes Pre-Procedure Day -5 Hold Hold Hold Pre-Procedure Day -4 Hold Hold Hold Pre-Procedure Day -3 *** mg *** mg Hold Pre-Procedure *** mg *** mg Hold Day - 2 Pre-Procedure Day -1 *** mg Hold Hold Procedure Day Hold Hold *** mg (*** tablets) After your procedure, ask your proceduralist if it is safe to restart warfarin and enoxaparin at the times listed Post Procedure Day 1 Hold *** mg *** mg (*** tablets) Post Procedure Day 2 *** mg *** mg *** mg (*** tablets) Post Procedure Day 3 *** mg *** mg *** mg (*** tablets) Post Procedure Day 4 *** mg *** mg *** mg (*** tablets) Post Procedure Day 5 *** mg To Be Determined To Be Determined Check INR KEY Dark gray shaded cells: no doses administered Unshaded cells: doses administered Copyright © 2023 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 02/2023 Effective 2/17/2023. Contact CCKM@uwhealth.org for previous versions High Bleed Risk Procedure Example Bridge Plan Date Enoxaparin AM Enoxaparin PM Warfarin Notes Pre-Procedure Day -5 Hold Hold Hold Pre-Procedure Day -4 Hold Hold Hold Pre-Procedure Day -3 *** mg *** mg Hold Pre-Procedure *** mg *** mg Hold Day - 2 Pre-Procedure Day -1 *** mg Hold Hold Procedure Day Hold Hold *** mg (*** tablets) After your procedure, ask your proceduralist if it is safe to restart warfarin and enoxaparin at the times listed Post Procedure Day 1 Hold Hold *** mg (*** tablets) Post Procedure Day 2 Hold Hold vs *** mg *** mg (*** tablets) Post Procedure Day 3 Hold vs *** mg *** mg *** mg (*** tablets) Post Procedure Day 4 *** mg *** mg *** mg (*** tablets) Post Procedure Day 5 *** mg To Be Determined To Be Determined Check INR KEY Dark gray shaded cells: no doses administered Diagonal line shaded cells: determine whether to administer doses based on bleeding risk Unshaded cells: doses administered Copyright © 2023 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission. Contact: CCKM@uwhealth.org Last Revised: 02/2023 Effective 2/17/2023. Contact CCKM@uwhealth.org for previous versions