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. 2021 Oct 3;8(10):126. doi: 10.3390/jcdd8100126

Table 4.

Management of VKAs and NOACs in patients undergoing non-cardiac surgery [1,29].

VKAs ➢ Elective surgery
• Minor bleeding risk surgery: no change in oral anticoagulation therapy is needed but keep INR levels in the lower therapeutic range.
• Low/high bleeding risk surgery: take the last dose 3–5 days before surgery; when INR is ≤1.5, surgery can be performed safely.
➢ VKAs should be resumed on day 1 or 2 after surgery depending on the patient’s hemostatic status, but no less than 12 h after the procedure.
➢ If high risk of thromboembolism 1, bridging therapy with UFH or LMWH 2 needs to be implemented.
➢ In case of urgent/emergent surgery, immediately discontinue. If needed, reversal with vitamin K or fresh-frozen plasma/PCCs.
NOACs ➢ Elective surgery
Take the last dose before surgery according to CrCl:
• Minor bleeding risk surgery: ≥12 h or 24 h 1
• Low bleeding risk surgery:
- apixaban/edoxaban/rivaroxaban ≥24 h 2
- dabigatran ≥ 24–48 h 3
• High bleeding risk surgery:
- apixaban/edoxaban/rivaroxaban ≥48 h 4
- dabigatran ≥48–96 h 5
➢ No bridging with heparin required.
➢ In case of urgent/emergent surgery immediately discontinue. If needed, reversal with idaracizumab (dabigatran) or PCCs or aPCCs.

aPCCs, activated prothrombin complex concentrate; CrCL, creatinine clearance; INR, international normalized ratio; LMWH, low molecular weight heparin; NOACs, non-vitamin K antagonist oral anticoagulants; PCCs, prothrombin complex concentrate; UFH, unfractionated heparin; VKAs, vitamin K antagonists. 1 Patients with at least one of the following: AF with a CHA2DS2-VASc score ≥ 4, mechanical prosthetic heart valves, newly inserted biological prosthetic heart valves, mitral valvular repair (within the past 3 months), recent venous thromboembolism (within 3 months), thrombophilia. 2 CrCl > 30 mL/min: ≥24 h; CrCl < 29 mL/min: ≥36 h; CrCl < 15 mL/min: not indicated. 3 CrCl ≥ 80 mL/min: ≥24 h; CrCl 50–79 mL/min: ≥36 h; CrCl 30–49 mL/min: ≥48; CrCl < 29 mL/min: not indicated. 4 CrCl > 15 mL/min: ≥48 h; CrCl < 15 mL/min: not indicated. 5 CrCl ≥ 80 mL/min: ≥48 h; CrCl 50–79 mL/min: ≥72 h; CrCl 30–49 mL/min: ≥96; CrCl < 29 mL/min: not indicated.