66
Management
Table 18. Timing of Discontinuation of Oral Anticoagulants
in Patients With AF Scheduled to Undergo
an Invasive Procedure or Surgery in Whom
Anticoagulation is to Be Interrupted
Anticoagulant
Low Bleeding Risk
Procedure
High Bleeding
Risk Procedure
Apixaban (CrCl >25 mL/min)*
1 d
†
2 d
Dabigatran (CrCl >50 mL/min) 1 d 2 d
Dabigatran (CrCl 30–50 mL/min) 2 d 4 d
Edoxaban (CrCl >15 mL/min) 1 d 2 d
Rivaroxaban (CrCl >30 mL/min) 1 d 2 d
Warfarin 5 d for a target INR <1.5
2–3 d for a target INR <2
5 d
* For patients on DOAC with creatinine clearance lower than the values in the table, few
clinical data exist. Consider holding for an additional 1 to 3 days, especially for high
bleeding risk procedures.
†
e number of days is the number of full days before the day of surgery in which the patient
does not take any dose of anticoagulant. e drug is also not taken the day of surgery. For
example, in the case of holding a twice daily drug for 1 day, if the drug is taken at 8 pm, and
surgery is at 8 am, at the time of surgery, it will be 36 hours since the last dose was taken.
6.8.1. AF Complicating Acute Coronary Syndrome or
Percutaneous Coronary Intervention
COR LOE
Recommendations
1 A 1. In patients with AF and an increased risk for stroke who
undergo PCI, DOACs are preferred over VKAs in combination
with APT to reduce the risk of clinically relevant bleeding.
1 A 2. In most patients with AF who take oral anticoagulation and
undergo PCI, early discontinuation of aspirin (1–4 wk) and
continuation of dual antithrombotic therapy (DAT) with
OAC and a P2Y12 inhibitor is preferred over triple therapy
(OAC, P2Y12 inhibitor, and aspirin) to reduce the risk of
clinically relevant bleeding.
6.8. Anticoagulation in Specific Populations
