Suggested postoperative management of patients receiving NOACs
| NOAC | MINOR SURGERY OR PROCEDURE (LOW BLEEDING RISK) | MAJOR SURGERY OR PROCEDURE OR SPINAL ANESTHESIA (HIGH BLEEDING RISK)* |
|---|---|---|
| Dabigatran | Resume 1 d after surgery (24 h postoperative), 150 (or 110) mg twice daily | Resume 2 d after surgery (48 h postoperative), 150 (or 110) mg twice daily |
| Rivaroxaban | Resume 1 d after surgery (24 h postoperative), 20 mg once daily | Resume 2 d after surgery (48 h postoperative), 20 mg once daily |
| Apixaban | Resume 1 d after surgery (24 h postoperative), 5 mg twice daily | Resume 2 days after surgery (48 h postoperative), 5 mg twice daily |
NOAC—new oral anticoagulant.
↵* An alternative approach would be to give a reduced dose of an NOAC for the initial 1–3 d. For example, dabigatran, 75 mg twice daily; rivaroxaban, 10 mg daily; or apixaban, 2.5 mg twice daily.
Data from Douketis22 and Thrombosis Canada.24