Perioperative Management of DOACs Problem: ✖ Each year approximately 250,000 patients on chronic anticoagulation in North America require an invasive or surgical procedure. ✖ For patients on warfarin, this requires an extended interruption for at least 5 days. ✖ For patients taking direct acting oral anticoagulants (DOACs) the interruption period is shorter. However, there is no commonly available lab test to assess for anticoagulant effect prior to surgery. Solution: ✔ Use recent creatinine clearance (calculated using actual body weight) to determine timing of DOAC interruption per treatment table. ✔ Assess patient-specific and procedural bleeding risk ✔ Procedures with a very low bleeding risk may not require anticoagulation interruption. Discontinuation of Therapy • Dabigatran (direct thrombin inhibitor) • Apixaban, Edoxaban, Rivaroxaban (anti-XA inhibitor) Resumption of Therapy • Low Bleed-Risk Surgery: 24 hours postoperative • High Bleed-Risk Surgery: 48-72 hours postoperative #DOAC #Perioperative #Management #Treatment #pharmacology #preop
