Management of Non-Vitamin K Antagonist Oral Anticoagulants in the Perioperative Setting

Table 10

Perioperative management of NOACs (dabigatran and rivaroxaban)—Proposal for recommendations from the GIHP (“Groupe d’Intérêt en Hémostase Périopératoire”).

Measured concentration	Recommendations
<30 ng/mL	Operate
30–200 ng/mL	Wait up to 12 h and obtain new dosage or (if time is not compatible with emergency); Operate, if abnormal bleeding: antagonise the anticoagulant effect
200–400 ng/mL	Wait up to 12 h and obtain new dosage or (if time is not compatible with emergency); Maximise delay surgery; Discuss hemodialysis, especially if CrCl < 50 mL/min (with dabigatran only); Operate, if abnormal bleeding: antagonise
>400 ng/mL	Overdose-Major haemorrhagic risk; Discuss haemodialysis before surgery (with dabigatran only)