63
6.7. Periprocedural Management
COR LOE
Recommendations
1 B-R* 1. In patients with AF (excluding those with recent stroke or
TIA, or a mechanical valve) and on oral anticoagulation with
either warfarin* or DOAC
†
who are scheduled to undergo
an invasive procedure or surgery, temporary cessation of
oral anticoagulation without bridging anticoagulation is
recommended.
B-NR
†
1 A 2. In patients with AF on warfarin anticoagulation and an annual
predicted risk of thromboembolism of ≥5% undergoing PM
or defibrillator implantation or generator change, continued
anticoagulation is recommended in preference to interruption
of warfarin and bridging anticoagulation with heparin to
reduce the risk of pocket hematoma.
2a A 3. In patients with AF with CHA
2
DS
2
-VASc score ≥2 or
equivalent risk of stroke, on DOAC anticoagulation and
undergoing PM or defibrillator implantation or generator
change, either uninterrupted or interrupted DOAC is
reasonable.
1 B-NR 4. In patients with AF on DOAC anticoagulation and scheduled
to undergo an invasive procedure or surgery that cannot be
performed safely on uninterrupted anticoagulation, the timing
of interruption of DOAC should be guided by the specific
agent, renal function, and the bleeding risk of the procedure
(Table 18).
2a B-NR 5. In patients with AF on DOAC anticoagulation that has been
interrupted for an invasive procedure or surgery, in general,
resumption of anticoagulation the day after low bleeding
risk surgery and between the evening of the second day and
the evening of the third day after high bleeding risk surgery
is reasonable, as long as hemostasis has been achieved and
further bleeding is not anticipated.
3: Harm B-R 6. In patients with AF on warfarin anticoagulation, who are
undergoing surgeries or procedures for which they are holding
warfarin, except in patients with mechanical valve or recent
stroke or TIA, bridging anticoagulation with low-molecular-
weight heparin should not be administered.
* B-R LOE applies to the data on warfarin.
†
B-NR LOE applies to the data on DOAC.
