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. Author manuscript; available in PMC: 2019 Apr 1.
Published in final edited form as: Surg Clin North Am. 2018 Feb 3;98(2):219–238. doi: 10.1016/j.suc.2017.11.003

Table 4.

Bridging and reversal strategy for DOACs.

Agent Mechanism of Action # days to hold for minor procedures # days to hold for major procedures Reversal Agent Alternative Treatment Option Bridging therapy required
Apixaban Factor Xa inhibitor 1 (2 doses) 2 (4 doses) Unavailable

  • 4 Factor PCC (Kcentra)

  • Factor VIIa

  • Tranexamic acid

  • Hemodialysis

 No
Rivaroxaban Factor Xa inhibitor 1 (1 dose) 2 (2 doses) Unavailable

  • 4 Factor PCC (Kcentra)

  • Factor VIIa

  • Tranexamic acid

 No
Dabigatran Direct thrombin inhibitor 1 (2 doses) *hold for 2 days if renal insufficiency 2 (4 doses) *hold 4 days if renal insufficiency Idarucizumab

  • 4 Factor PCC (Kcentra)

  • Factor VIIa

  • Tranexamic acid

 No
Edoxaban Factor Xa inhibitor 1 (1 dose) 2 (2 doses) Unavailable

  • 4 Factor PCC (Kcentra)

  • Factor VIIa

  • Tranexamic acid

 No