The recommended pre-operative workup for patients taking anticoagulants involves
stratifying both thromboembolic & bleeding risk, determining appropriate timing for
medication interruption, & deciding whether bridging therapy is needed. The
specific approach depends on the type of anticoagulant, renal function, and
procedure-related bleeding risk.
- Direct Oral Anticoagulants (DOACs)
- For apixaban, rivaroxaban, and Edoxaban, the American College of Chest Physicians recommends stopping these agents 1-2 days before low-to-moderate bleeding risk procedures and 2 days before high bleeding risk procedures.
- For dabigatran, interruption timing depends on renal function.
- With normal renal function (CrCl ≥50 mL/min), stop 1-2 days before low-risk procedures and 2 days before high-risk procedures.
- With impaired renal function (CrCl <50 mL/min), extend interruption to 3-4 days before high-risk procedures due to predominantly renal clearance.
