Table 3b.

Timings of when to stop NOACs prior to elective surgery according to surgical bleeding risk and renal function

	Dabigatran		Apixaban		Rivaroxaban
If no clinically important bleeding risk, then perform surgery at trough level (ie ≥12 hours or ≥48 hours after last intake, depending on once daily or twice daily regimen)
	Bleeding risk
Renal function	Low risk	High risk	Low risk	High risk	Low risk	High risk
CrCl ≥80 mL/min	≥24 hours	≥48 hours	≥24 hours	≥ 48hours	≥24 hours	≥48 hours
CrCl 50–80 mL/min	≥36 hours	≥72 hours
CrCl 30–50 mL/min	≥48 hours	≥96 hours
CrCl 15–30 mL/min	Not indicated		≥36 hours	≥ 48hours	≥36 hours	≥48 hours
CrCl <15 mL/min	Not indicated

NOAC = non-vitamin K oral anticoagulant

Adapted from the European Heart Rhythm Association recommendations.⁴⁶