Preventive Strategies against Bleeding due to Nonvitamin K Antagonist Oral Anticoagulants

Table 4

Perioperative management of NOACs (dabigatran and rivaroxaban)—proposal for recommendations from the GIHP (Groupe d’Intérêt en Hémostase Périopératoire) [29].

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