Review Article

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

Table 6

Schemes of discontinuation of NOACs.

DabigatranRivaroxabanApixaban

Baron et al. [12]CrCl ≥ 50 mL/min: 1 or 2 days
CrCl < 50 mL/min: 3–5 days
≥1 day if CrCl normal
CrCl 60–90 mL/min: 2 days
CrCl 30–59 mL/min: 3 days
CrCl 15–29 mL/min: 4 days
CrCl > 60 mL/min: 1 or 2 days
CrCl 50–59 mL/min: 3 days
CrCl 30–49 mL/min: 5 days

Liew et al. [64]No/minimal residual effect at surgery (4-5 drug half-lives)
CrCl > 50 mL/min: 3 days
CrCl 30–50 mL/min: 4 to 5 days
Mild-moderate effect at surgery (2-3 drug half-lives)
CrCl > 50 mL/min: 2 days
CrCl 30–50 mL/min: 3 days
No/minimal residual effect at surgery (4-5 drug half-lives)
CrCl > 50 mL/min: 3 days
CrCl 30–50 mL/min: 4 to 5 days
Mild-moderate effect at surgery (2-3 drug half-lives)
CrCl > 50 mL/min: 2 days
CrCl 30–50 mL/min: 3 days
No/minimal residual effect at surgery (4-5 drug half-lives)
CrCl > 50 mL/min: 3 days
CrCl 30–50mL/min: 4 to 5 days
Mild-moderate effect at surgery (2-3 drug half-lives)
CrCl > 50 mL/min: 2 days
CrCl 30–50 mL/min: 3 days

Kozek-Langenecker [93]2 days-interval may be sufficient for low-risk intervention
4 days at least for high risk intervention and/or CrCl < 50 mL/min
1 day for low-bleeding interventions
2 days in high bleeding risk interventions
1 day for low-bleeding interventions
2 days in high bleeding risk interventions

Spyropoulos and Douketis [62]CrCl > 50 mL/min:
Low risk bleeding surgery°:
last dose 2 days before surgery
High risk bleeding surgery:
Last dose 3 days before surgery
CrCl 30–50 mL/min:
Low risk bleeding surgery°:
Last dose 3 days before surgery
High risk bleeding surgery:
Last dose 4-5 days before surgery
CrCl > 30 mL/min:
Low risk bleeding surgery°:
last dose 2 days before surgery
High risk bleeding surgery:
Last dose 3 days before surgery
CrCl 15–29.9 mL/min:
Low risk bleeding surgery°:
Last dose 3 days before surgery
High risk bleeding surgery:
Last dose 4 days before surgery
CrCl > 50 mL/min:
Low risk bleeding surgery°:
last dose 2 days before surgery
High risk bleeding surgery:
Last dose 3 days before surgery
CrCl 30–50 mL/min:
Low risk bleeding surgery°:
Last dose 3 days before surgery
High risk bleeding surgery:
Last dose 4 days before surgery

Sié et al. [13]Low risk procedure1: 1 day
Other procedures than low risk bleeding procedures2:
stop 5 days before surgery/invasive procedures
Low risk procedure1: 1 day
Other procedures than low risk bleeding procedures2:
stop 5 days before surgery/invasive procedures
Low risk procedure1: 1 day
Other procedures than low risk bleeding procedures2:
stop 5 days before surgery/invasive procedures

Low-risk bleeding surgery: 2-day risk of major bleed 0%–2%; High-risk bleeding surgery: 2%–4%.
1Low risk procedure: in case of bleeding, if it occurs, will be low abundance, non-critical in its location and/or easily controlled by simple mechanical hemostasis; 2High risk procedure: the probability of significant bleeding cannot be excluded or, any surgery that is usually hemorrhagic or for which the risk of bleeding would be unacceptable.