Table 4.

Perioperative recommendations13,28–31

	Renal function	Low bleeding risk or minor surgery	High bleeding risk or major surgery
Preoperative management	CrCl >50 mL/min	Hold 24 hours prior to surgery (skip two doses)	Hold 48 hours prior to surgery (skip four doses)
	CrCl 30–50 mL/min	Hold 48 hours prior to surgery (skip four doses)	Hold 72 hours prior to surgery (skip six doses)
Postoperative management	CrCl >50 mL/min or CrCl 30–50 mL/min	Resume 24 hours postoperative	Resume 48–72 hours postoperative

Abbreviation: CrCl, creatinine clearance.