Suggested preoperative management of patients taking NOACs
| DRUG (DOSE REGIMEN) | RENAL FUNCTION | MINOR SURGERY OR PROCEDURE (LOW BLEEDING RISK) | MAJOR SURGERY OR PROCEDURE OR SPINAL ANESTHESIA (HIGH BLEEDING RISK) |
|---|---|---|---|
| Dabigatran (twice daily) | |||
| • Half-life = 14 h | Normal renal function or mild impairment (eGFR > 50 mL/min) | Last dose: 2 d before surgery (skip 2 doses) | Last dose: 3 d before surgery (skip 4 doses) |
| • Half-life = 15–18 h | Moderate renal impairment (eGFR 30–50 mL/min) | Last dose: 3 d before surgery (skip 4 doses) | Last dose: 4–5 d before surgery (skip 6–8 doses) |
| Rivaroxaban (once daily) | |||
| • Half-life = 9 h | Normal renal function or mild to moderate impairment (eGFR > 30 mL/min) | Last dose: 2 d before surgery (skip 1 dose) | Last dose: 3 d before surgery (skip 2 doses) |
| Apixaban (twice daily) | |||
| • Half-life = 9 h | Normal renal function or mild to moderate impairment (eGFR > 30 mL/min) | Last dose: 2 d before surgery (skip 1 dose) | Last dose: 3 d before surgery (skip 4 doses) |
eGFR—estimated glomerular filtration rate, NOAC—new oral anticoagulant.
Data from Douketis22 and Thrombosis Canada.24