Table 3b.

Timings of when to stop NOACs prior to elective surgery according to surgical bleeding risk and renal function

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 functionLow riskHigh riskLow riskHigh riskLow riskHigh 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/minNot indicated≥36 hours≥ 48hours≥36 hours≥48 hours
CrCl <15 mL/minNot indicated
  • NOAC = non-vitamin K oral anticoagulant

  • Adapted from the European Heart Rhythm Association recommendations.46