Figure 15.

Stopping and re-initiation of NOAC therapy in elective surgery. Yellow star—Time point of the intervention/operation. Parentheses indicate optional pre-/postoperative intake, especially in patients not at high risk of drug accumulation/bleeding. Consider +24 h of interruption in situations likely resulting in increased plasma levels [e.g. body weight < 50 kg, significant interactions (see ‘Pharmacokinetics and drug-drug interactions of NOACs' section)]. ^*Intake of this dose of dabigatran if CrCl is in the indicated range; otherwise skip this dose. ^**Consider measurement of plasma levels in very special situations, e.g. highest risk neurosurgery/cardiac surgery, severely impaired renal function, combination of factors predisposing to higher NOAC levels (see ‘NOAC plasma level measurements: technical approach, indications, pitfalls' section). Rivaroxaban needs to be taken with food for stroke prevention in AF, which needs to be considered (also) in the post-operative setting. AF, atrial fibrillation; CrCl, creatinine clearance; NOAC, non-vitamin K antagonist oral anticoagulant.