Perioperative Anticoagulation Algorithm
PERIOPERATIVE ANTICOAGULATION GUIDELINE/DOAC MANAGEMENT
Options for anticoagulation continue to expand with the use of direct oral anticoagulants (DOACs). While the thromboembolic risk is determined by the patient's condition, the perioperative management of DOACs is vastly different and varied. Bridging is not recommended with DOACs.
DOAC Patient is Surgery
Taking
Bleeding
Risk
Apixaban (Eliquis)
Dabigatran (CrCl>50ml/min) Dabigatran (CrCl1 year ago no moderate to high thrombotic risk conditions
VTE more than 3 months ago no other risk factors Nonsevere thrombophilic conditions, including
hereditary disorders
Bridging No Bridging
Check INR 7 days prior to surgery Last dose of warfarin 6 days prior to procedure (for INR 2-3, if INR 3-4.5, last dose warfarin 7 days prior) If CrCl>30, initiate enoxaparin* 1 mg/kg SQ 36 hrs after last warfarin dose and continue q12 hrs If CrCl ................
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