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# DOACs: apixaban, rivaroxaban, edoxaban, dabigatran
- URL: https://www.preanaesthesia.com/clinician-reference/doacs-apixaban-rivaroxaban-edoxaban-dabigatran/
- Published: 2026-09-13T04:54:48.000Z
- Updated: 2026-09-13T19:19:56.000Z
- Description: Review how procedure bleeding risk, renal function and regional anaesthesia affect interruption and restarting of DOACs.
- Author: preetam satish
- Tags: #clinician, #Import 2026-09-12 18:04

This reference summarises CHEST guidance on direct oral anticoagulants (DOACs) for elective procedures.

## Interruption before the procedure

Apixaban, rivaroxaban and edoxaban are generally interrupted 1 day before low-to-moderate bleeding-risk procedures and 2 days before high-bleeding-risk procedures. Dabigatran interruption is longer when renal function is impaired: 1-4 days depending on bleeding risk and creatinine clearance. Perioperative heparin bridging is generally not recommended for DOAC interruption.

## Regional anaesthesia and restarting treatment

These are general elective-procedure intervals, not neuraxial or deep-block timing rules. Renal function, drug dose, catheter management and local regional-anaesthesia guidance may require longer intervals. The timing of restarting treatment depends on assessment of haemostasis and postoperative bleeding risk.

## Sources

- [CHEST 2022 antithrombotic guideline](https://www.chestnet.org/guidelines-and-topic-collections/guidelines/pulmonary-vascular/perioperative-management-of-antithrombotic-therapy)

## Related reading

- [Beta blockers](https://www.preanaesthesia.com/clinician-reference/beta-blockers/)
- [Statins](https://www.preanaesthesia.com/clinician-reference/statins/)
- [ACE inhibitors / ARBs / RAAS inhibitors](https://www.preanaesthesia.com/clinician-reference/ace-inhibitors-arbs-raas-inhibitors/)
- [Metformin](https://www.preanaesthesia.com/clinician-reference/metformin/)
- [SGLT2 inhibitors](https://www.preanaesthesia.com/clinician-reference/sglt2-inhibitors/)