Timings of when to stop NOACs prior to elective surgery according to surgical bleeding risk and renal function
| Dabigatran | Apixaban | Rivaroxaban | ||||
|---|---|---|---|---|---|---|
| If no clinically important bleeding risk, then perform surgery at trough level (ie ≥12 hours or ≥48 hours after last intake, depending on once daily or twice daily regimen) | ||||||
| Bleeding risk | ||||||
| Renal function | Low risk | High risk | Low risk | High risk | Low risk | High risk |
| CrCl ≥80 mL/min | ≥24 hours | ≥48 hours | ≥24 hours | ≥ 48hours | ≥24 hours | ≥48 hours |
| CrCl 50–80 mL/min | ≥36 hours | ≥72 hours | ||||
| CrCl 30–50 mL/min | ≥48 hours | ≥96 hours | ||||
| CrCl 15–30 mL/min | Not indicated | ≥36 hours | ≥ 48hours | ≥36 hours | ≥48 hours | |
| CrCl <15 mL/min | Not indicated | |||||
NOAC = non-vitamin K oral anticoagulant
Adapted from the European Heart Rhythm Association recommendations.46