Based upon list below, choose surgical bleeding risk to see the interruption and resumption protocol.
DOAC periop mgmt
Minimal bleeding risk surgery/procedure
- do not interrupt DOAC use
- for those on BID agent, patient can skip dose on morning of procedure
- for those on qDay agent, patient can take daily dose in evening post-procedure
The PAUSE trial protocol was transformed into the recommendations of the JAMA 8-2024 and ACC 9-2024 guidelines with the following classification of surgical and procedural bleeding risk.
High Bleed Risk Surgery (30 day risk major bleed ≥
2%):
- Any surgery with spinal or epidural anesthesia
- Major cancer surgery (eg, lung, esophagus, gastric, colon, kidney, or hepatobiliary)
- Major orthopedic surgery (eg, hip or knee replacement)
- Major reconstructive plastic surgery (eg, cancer resection)
- Noncancer major thoracoabdominal surgery (eg, colectomy)
- Transurethral prostate or bladder resection
- Selected biopsies (eg, kidney)
- Selected gastrointestinal procedures (eg, ERCP)
- Surgery involving highly vascular organs (eg, kidneys)
- Surgery involving closed space areas (eg, cardiac)
- Deep nerve block procedures
Low or Moderate Bleeding Risk Surgery (30 day risk major bleed 0-2%):
- Laparoscopic cholecystectomy
- Abdominal hernia repair
- Abdominal hysterectomy
- Lymph node biopsy
- Foot or hand surgery
- Coronary angiography with femoral access
- GI endoscopy with or without biopsy
- Colonoscopy with or without biopsy
- Hemorrhoidal surgery
- Bronchoscopy with or without biopsy
Minimal Bleeding Risk Surgery (30 day risk major bleed 0%):
- Cardiac device implantation (eg, pacemaker or cardioverter-defibrillator device)
- Coronary angiography with wrist access
- Minor dermatologic procedures (eg, excision BCC and SCC cancers, actinic keratoses, or premalignant or cancerous skin nevi)
- Phacoemulsification (cataract) procedures
- Minor dental procedures (eg, dental extractions, restorations, cleanings, or fillings)
