Drug and route of administration | Mechanism of action | Indications | Half-life | When to withhold# | When to restart h | Management of bleeding |
Warfarin p.o. | Inhibits production of vitamin K-dependent clotting | VTE, AF and mechanical heart valves | 40 h | 5 days¶ | 24 | Vitamin K (p.o./i.v.), FFP, PCC, rFVIIa |
Dabigatran p.o. | Reversible direct thrombin inhibitor | VTE and non-valvular AF | 15 h | 1–2 days+ | 24 | Idarucizumab, dialysis, PCC, rFVIIa |
Apixaban p.o. | Reversible selective factor Xa inhibitor | VTE and non-valvular AF | 12 h | 1–2 days+ | 24 | Andexanet alfa##, FFP and PCC, rFVIIa |
Edoxaban p.o. | Selective factor Xa inhibitor | VTE after parenteral anticoagulant and non-valvular AF | 12 h | 1–2 days+ | 24 | Andexanet alfa##, FFP and PCC, rFVIIa |
Rivaroxaban p.o. | Reversible selective factor Xa inhibitor | VTE and non-valvular AF | 5–9 h | 1–2 days+ | 24 | Andexanet alfa##, FFP and PCC, rFVIIa |
UFH i.v./s.c. | Inactivates thrombin and activated factor X | VTE, ACS, mechanical heart valves, AF and bridging | 60–90 min | 4–6 h§ | 12–24 | Protamine sulfate |
LMWH s.c. | Selectively binds to antithrombin | VTE, ACS, mechanical heart valves, AF and bridging | 3–5 h | 24 h+ | 24–72 | Andexanet alfa##, protamine sulfate, rFVIIa |
Fondaparinux s.c. | Inhibits activated factor X indirectly | VTE, HIT and ACS | 17 h | 72 h+ | 24–72 | rFVIIa |
Argatroban i.v. | Reversible direct thrombin inhibitor | HIT, patients with HIT undergoing PCI | 45 min | 3 hƒ | 12–24 | rFVIIa |
Desirudin i.v./s.c. | Reversible direct thrombin inhibitor | VTE prophylaxis after hip replacement | 2–3 h | 6–8 h+,§ | 12–24 | rFVIIa |
Bivalirudin i.v. | Reversible direct thrombin inhibitor | HIT, ACS undergoing PCI | 25 min | 2 h+ | 12–24 | rFVIIa |
UFH: unfractionated heparin; LMWH: low-molecular-weight heparin; VTE: venous thromboembolism; AF: atrial fibrillation; FFP: fresh frozen plasma; PCC: prothrombin complex concentrate; rFVIIa: recombinant activated factor VII; ACS: acute coronary syndrome; HIT: heparin-induced thrombocytopenia; PCI: percutaneous coronary intervention. #: consider withholding the medications for a longer period in patients prone to bleeding complications; ¶: assess the international normalised ratio (INR) at least 7 days before bronchoscopy, and check the INR the day of the bronchoscopy; +: in patients with renal disease, consider withholding these agents for a longer period prior to bronchoscopy; §: withhold these agents for a longer period prior to bronchoscopy after subcutaneous administration; ƒ: in patients with liver disease, consider withholding these agents for a longer period prior to bronchoscopy; ##: not yet approved for use in the USA.