What is a reasonable protocol for how long to hold warfarin and/or DOACs before cardiac catheterization? 

Thanks for bringing up this question Dr. @Dr. First Last.

This is one of the most common questions my nurses ask me when scheduling cardiac catheterizations and other procedures.

Here is my answer based on experience and literature. As such, there is no formal study, but the risk of thromboembolism ...

Great question and I will share as an electrophysiologist with some data from interventional cardiologists. Not sure if this moves the needle for being comfortable with more anticoagulation present.

The 2021 SCAI expert consensus for best practices in the cardiac cath lab (Naidu et al., PMID 33909349...

Our cath lab routine is to hold DOACs for 24 hours, except for Pradaxa which we hold for 48 hours. We do not check INR since studies show it does not reflect coagulation status with DOACs.

Coumadin is held for 3-5 days depending on INR, Goal INR =/< 1.6 procedure day.

For uncomplicated procedures an...