Guide Peri-Op Management of Direct Oral Anticoagulants Flashcards

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1

How to manage DOACS around surgery?

  • Holding
  • Bridging
  • Reversing

2

Holding DOACS BEFORE surgery

  • Hold x 1 day before for low bleeding risk: colonoscopy or upper endoscopy
  • Hold x 2 days before for high bleeding risk: abdominal or vascular surgery

3

Holding DOACS AFTER surgery

  • Restart DOACS 1 day after low bleeding risk
  • Restart DOACS 2 -3 days after high bleeding risk

4

Holding DOACS in pts with decreased renal function

  • If CrCl < 50, Hold Pradaxa for 2 days before low bleeding risk
  • Hold Pradaxa for 4 days before high bleeding risk

5

DOACs with minimal bleeding risk...such as tooth extraction or skin biopsy

  • Delay DOACs until 4-6 hours post-op. This means skipping the morning dose of twice daily DOACs

6

What is bridging?

  • Dont routinely recommend bridging with injectable anticoagulant (Loveno) while DOACs is held

7

Reversal agent for factor Xa inhibitors

  • Andexxa >< Apixaban (Eliquis) or Rivaroxaban (Xarelto)
  • 4 factor prothromnin complex concentrate: Kcentra
  • Idarucizumab (Praxbind) >< Dabigatran