Do You Hold Eliquis For Tee?

Do You Hold Eliquis For Tee?

When it comes to the use of Eliquis for Transesophageal Echocardiography (TEE), there are important considerations to be aware of. As a healthcare professional, you may be wondering about the best approach in managing anticoagulation therapy during this procedure. Let's explore the guidelines and recommendations surrounding the use of Eliquis for TEE and understand the implications for patient care.

Transesophageal Echocardiography (TEE) has become an invaluable diagnostic tool for evaluating cardiac structures and function. It provides detailed images of the heart using an ultrasound probe inserted into the esophagus. However, the use of TEE carries an inherent risk of embolic events due to manipulation of the probe, which can dislodge blood clots. As Eliquis is an anticoagulant commonly used to reduce the risk of stroke, determining whether or not to hold it during TEE presents a clinical dilemma. Striking a balance between ensuring patient safety and minimizing the risk of thromboembolic events is crucial in optimizing outcomes for patients undergoing TEE.

Do You Hold Eliquis For Tee?

Understanding the Role of Eliquis in Transesophageal Echocardiography (TEE)

Transesophageal echocardiography (TEE) is a non-invasive diagnostic imaging technique that allows healthcare professionals to assess the structure and function of the heart. It involves inserting a specialized ultrasound probe into the esophagus to obtain detailed images of the heart and its surrounding structures. TEE is commonly performed for various cardiovascular conditions, including atrial fibrillation, valvular heart diseases, and intracardiac masses. During TEE, there might be concerns regarding the use of anticoagulant medications such as Eliquis. In this article, we will explore whether it is necessary to hold Eliquis for TEE procedures and understand the implications of its use.

Understanding Eliquis and Its Mechanism of Action

Eliquis, with the generic name apixaban, is an oral anticoagulant medication belonging to the class of direct oral anticoagulants (DOACs). It acts by inhibiting a key clotting factor known as factor Xa, thus preventing the formation of blood clots. It is primarily used for preventing stroke and systemic embolism in patients with atrial fibrillation, as well as for the treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Unlike traditional anticoagulants like warfarin, Eliquis has a predictable pharmacokinetic profile and does not require routine monitoring of coagulation parameters. It offers several advantages, including a lower risk of bleeding complications and fewer drug interactions. However, as with any anticoagulant medication, there are important considerations when undergoing invasive procedures like TEE.

The Importance of Anticoagulation in TEE

Anticoagulation plays a crucial role in TEE procedures as it helps reduce the risk of thromboembolic events that may occur during or after the examination. TEE involves the insertion of the ultrasound probe into the esophagus, which can potentially cause slight trauma to the blood vessels. This trauma may trigger the formation of blood clots, especially in individuals with pre-existing clotting disorders or conditions such as atrial fibrillation.

Patients who are taking anticoagulant medications like Eliquis are often at a higher risk of developing blood clots. Therefore, the decision of whether to hold Eliquis for TEE depends on various factors, including the individual's overall health, the reason for anticoagulation, and the perceived risk of embolic events during the procedure.

The Need to Hold Eliquis for TEE

Currently, there is no clear consensus on whether Eliquis needs to be held before TEE procedures. The decision is typically made on a case-by-case basis after weighing the potential benefits of reducing thromboembolic events against the risks of bleeding complications.

In some situations, the healthcare provider may opt to continue Eliquis during the TEE procedure, especially if the individual has a high risk of thromboembolic events or if they have a history of stroke or systemic embolism. In such cases, the professionals closely monitor the individual for any signs of bleeding and take appropriate actions if necessary.

On the other hand, there are instances where Eliquis may be temporarily held before TEE. This decision is often made in consultation with the individual's cardiologist or primary care physician and may depend on various factors like the individual's bleeding risk, the invasiveness of the procedure, and the urgency of the TEE.

The Importance of Individualized Approach

It is crucial to emphasize that the decision to hold or continue Eliquis for TEE should be individualized and based on a thorough assessment of the risks and benefits for each patient. Healthcare professionals, including cardiologists, interventionalists, and anesthesiologists, must carefully consider the individual's overall health status, the presence of any cardiac conditions, and the specific indications for Eliquis therapy.

A multidisciplinary approach involving the patient, primary care physician, cardiologist, and the procedural team is essential for making informed decisions regarding Eliquis management during TEE. This collaborative effort ensures that the patient receives optimal care while minimizing the risk of both thromboembolic events and bleeding complications.

Safety Measures during TEE for Patients on Eliquis

If Eliquis is continued during a TEE procedure, it is essential to take appropriate safety measures to minimize the risk of bleeding complications. These measures may include:

  • Ensuring adequate hemostasis at the site of venous access before and after the procedure
  • Using appropriate size and type of sheaths and catheters to minimize trauma
  • Monitoring the patient's blood pressure and heart rate closely during the procedure to detect any signs of bleeding
  • Being prepared with appropriate reversal agents, such as prothrombin complex concentrate (PCC), in case of significant bleeding

Communication with the Procedural Team

Effective communication between the cardiology team, anesthesiologists, and nursing staff is vital during TEE procedures. It ensures everyone is aware of the patient's anticoagulation status and any specific considerations related to Eliquis therapy. This information helps guide the procedural team in managing the patient's care, especially if any unexpected bleeding occurs during or after the TEE.

Close collaboration and effective communication among the healthcare professionals involved in the TEE and Eliquis management contribute to the overall safety and positive outcomes for patients undergoing the procedure.


When it comes to holding Eliquis for TEE, there is no one-size-fits-all approach. The decision should be made on a case-by-case basis, considering the individual's overall health, bleeding risk, and perceived risk of thromboembolic events during the procedure. Effective communication and collaboration among healthcare professionals are crucial in ensuring the safety and optimal outcomes for patients on Eliquis undergoing TEE.

Do You Hold Eliquis For Tee?

Reasons to Consider Holding Eliquis for Tee

When it comes to transesophageal echocardiogram (TEE) procedures, the decision to hold or continue anticoagulation therapy, such as Eliquis, depends on several factors. While there is no definitive consensus, there are a few considerations:

  • Stroke risk: The CHA2DS2-VASc score and the individual patient's risk factors should be taken into account.
  • Bleeding risk: Assessing the patient's bleeding risk, such as previous major bleeding events or recent surgery, is crucial in making the decision.
  • Procedure-related bleeding risk: The clinician should evaluate the potential risk of bleeding associated with the TEE procedure, especially if biopsies or other interventions are planned.
  • Patient-specific factors: Factors such as patient preference and comorbidities should be considered, as they may influence the decision to continue or hold Eliquis.

In summary, the decision to hold Eliquis for a TEE procedure should be made on a case-by-case basis, weighing the individual patient's stroke and bleeding risks, as well as the potential bleeding risks associated with the procedure. Collaboration between the cardiologist, primary care physician, and hematologist is essential in determining the most appropriate course of action for each patient.

Key Takeaways:

  • Eliquis should be held before Transesophageal Echocardiogram (TEE) to reduce the risk of bleeding.
  • It is recommended to hold Eliquis for at least 48 hours before TEE.
  • Consult with the prescribing healthcare provider before stopping Eliquis.
  • The decision to hold Eliquis for TEE should be made on an individual basis.
  • Restarting Eliquis after TEE should be based on the risk of bleeding versus the benefit of anticoagulation.

Frequently Asked Questions

Eliquis is a commonly prescribed anticoagulant medication used to prevent blood clots. Many patients who are scheduled to undergo a transesophageal echocardiogram (TEE) may wonder if they need to hold their Eliquis before the procedure. Here are some frequently asked questions related to holding Eliquis for a TEE:

1. Can I continue taking Eliquis before a TEE?

It is generally recommended to hold Eliquis before a TEE. Eliquis increases the risk of bleeding, and the procedure itself may pose a risk of complications. To minimize the risk of bleeding during and after the TEE, your healthcare provider may advise you to temporarily stop taking Eliquis before the procedure. It is important to follow your healthcare provider's instructions and not make any changes to your medication regimen without consulting them.

Your healthcare provider will consider factors such as your individual medical history, the risks of stopping Eliquis, and the potential benefits of the TEE when making the decision to hold the medication. They will provide you with specific instructions on when to stop taking Eliquis and when it is safe to resume after the TEE.

2. How long before a TEE should I hold Eliquis?

The duration of holding Eliquis before a TEE can vary depending on individual factors. Generally, your healthcare provider may advise you to stop taking Eliquis a few days before the procedure to allow the medication to clear from your system and reduce the risk of bleeding. However, the specific timeline may differ from person to person.

You should consult your healthcare provider to determine the exact duration for holding Eliquis before your TEE. They will consider factors such as your kidney function, the dosage of Eliquis you take, and the specific requirements of the procedure to provide you with personalized instructions.

3. Are there any alternatives to holding Eliquis before a TEE?

In some cases, your healthcare provider may prescribe an alternative anticoagulant medication to replace Eliquis temporarily before a TEE. These medications may have different mechanisms of action and shorter durations of effect, which can help reduce the risk of bleeding during the procedure.

Your healthcare provider will carefully evaluate the potential risks and benefits of using an alternative medication and make the appropriate recommendation based on your individual medical history and the specifics of the TEE procedure.

4. What if I forget to hold my Eliquis before a TEE?

If you accidentally forget to hold your Eliquis before a TEE, it is important to inform your healthcare provider and the medical team performing the procedure. They will assess the situation and take necessary precautions to minimize the risk of bleeding and ensure your safety during the TEE.

It is always best to follow your healthcare provider's instructions and not make any changes to your medication regimen without consulting them beforehand to avoid any potential complications or risks.

5. When can I resume taking Eliquis after a TEE?

After a TEE, your healthcare provider will determine when it is safe for you to resume taking Eliquis. The specific timing may depend on factors such as the procedure's outcome, any potential complications, and the risk of bleeding.

Your healthcare provider will provide you with instructions on when to restart Eliquis, taking into account your individual medical history and the specifics of the procedure. It is important to follow their guidance to ensure your safety and minimize the risk of blood clot formation.

In summary, the decision to hold or continue Eliquis for transesophageal echocardiogram (TEE) should be based on a thorough assessment of the patient's individual circumstances and specific risks. TEE is an invasive procedure used to evaluate the heart's structure and function, and it carries a small risk of bleeding. However, the risk of thrombosis must also be considered, especially in patients with atrial fibrillation who are taking Eliquis for anticoagulation.

The decision to hold or continue Eliquis should be made in consultation with the patient's healthcare provider, evaluating the patient's bleeding risk, thrombotic risk, and potential benefits of uninterrupted anticoagulation. The decision may also depend on the type and indication for the TEE procedure. It is important to follow the healthcare provider's recommendations and to closely monitor the patient for any signs of bleeding or thrombotic events.