DOACS: Perioperative management
Preoperative assessment guidelines
Situation
How long should therapeutic Direct Oral Anticoagulants (DOACS) be discontinued prior to elective surgery?
Background
DOACS are widely used for therapeutic anticoagulation; indications include non-valvular atrial fibrillation thromboprophylaxis, thromboprophylaxis post arthroplasty and treatment of arterial/venous thromboembolism.
Advantages include fixed patient dosing and lack of requirement for therapeutic monitoring.
Without a routine therapeutic monitoring test, guidance is required as to when to discontinue DOACS prior to surgery.
Assessment
DOACs include Factor Xa Inhibitors (Rivaroxaban, Apixiban, Edoxaban) and Direct Thrombin inhibitors (Dabigatran):