Recommendations for timing of discontinuation of anticoagulation for elective surgery
| Drug | Timing of discontinuation | ||
|---|---|---|---|
| Warfarin | 5 days | ||
| Direct thrombin inhibitors (dabigatran) | CrCl ≥50 mL/min: 1–2 days CrCl <50 mL/min: 3–5 days | ||
| CrCl (mL/min) | Bleed risk: low | Bleed risk: high (days) | |
| ≥50 | 24 hours | 2-3 | |
| 30–50 | 2 days | 2-3 | |
| <30 | 2–4 days | >5 | |
| Factor Xa inhibitors | |||
| Rivaroxaban (Xarelto) | ≥24 hours ROCKET AF: ≥3 days | ||
| Apixaban (Eliquis) | Low-bleed risk: ≥24 hours High-bleed risk: ≥48 hours | ||
| Antiplatelet agents | |||
| Aspirin | High-CV risk/minor: continue Low CV/high-bleed risk: 7–10 days | ||
| Clopidogrel | 5 days | ||
Stents: bare metal stents—delay surgery for 6 weeks; drug eluding stents delay surgery for 6–12 months due to risk of occlusion; otherwise, consider continuing agents.
CV, cardiovascular.