DOACs: apixaban, rivaroxaban, edoxaban, dabigatran
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.