Two step process for guidance
(1) Identify the surgical bleeding risk as minimal, low or moderate, or high; then
(2) Interrupt and resume DOAC per visual schematic guidance
Guidance on perioperative DOAC mgmt has emerged with the landmark PAUSE trial (Douketis 2019, see ref), incorporated into the ACC 2024 guideline.
Note that the PAUSE trial was performed on roughly 3,007 atrial fibrillation patients including 1,007 at high bleeding risk, but not on patients with the other indication for DOAC's, VTE prevention and treatment.
DOAC's have such short half-lives that they are akin to oral enoxaparin (Lovenox) and do not need bridging. That said, some procedures tolerate bleeding less well than others, thus precise guidance about when to interrupt each agent is highly warranted