Stopping DOACs and warfarin before surgery

Gives the interval from the last DOAC dose to the procedure from the EHRA practical guide (by drug, creatinine clearance and minor, low or high bleeding risk), including neuraxial anaesthesia, and the warfarin plan with bridging only for high-risk mechanical valves.

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Anticoagulant

Patient and renal function

Cockcroft-Gault with actual body weight, as in the DOAC trials

Age

years

Weight

Creatinine

mg/dL

Or enter CrCl directly

mL/min

Procedural bleeding risk

EHRA 2021

When to stop before surgery

Choose the anticoagulant and the bleeding risk of the procedure.

References

Steffel J, et al. 2021 European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021;23:1612-1676.
Halvorsen S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022;43:3826-3924.
Douketis JD, et al. Perioperative management of patients with atrial fibrillation receiving a direct oral anticoagulant (PAUSE). JAMA Intern Med 2019;179:1469-1478.
Douketis JD, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation (BRIDGE). N Engl J Med 2015;373:823-833.
Horlocker TT, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: ASRA evidence-based guidelines (4th edition). Reg Anesth Pain Med 2018;43:263-309.