Timing for interruption of a direct oral anticoagulant (DOAC) before and after elective surgery
This strategy applies to all DOACs in individuals with normal kidney function (eg, CrCl >50 mL/min) and individuals taking apixaban, edoxaban, or rivaroxaban with CrCl 30 to 50 mL/min.
- For individuals taking dabigatran who have CrCl of 30 to 50 mL/min, omit an additional dose before the procedure.
- For individuals with severely reduced kidney function (CrCl of 15 to 30 mL/min), practice is uncertain, but a longer than 2-day duration of DOAC interruption should be considered alongside consultation with relevant specialists (nephrology, cardiology).
- For any DOAC and a high bleeding risk procedure, it may be reasonable to omit the DOAC for an additional postoperative day (5 days total interruption). Refer to UpToDate for additional details.
