Perioperative Direct Oral Anticoagulant Use

This study of 3007 patients with atrial fibrillation who were undergoing surgery enrolled patients to have:

1. Direct Oral Anticoagulants (DOACs) were omitted 1-day before a low-bleeding-risk procedure
2. DOACs were omitted 2 days before a high-bleeding-risk procedure
3. Patients with renal impairment had the pre-operative omission duration readjusted

Study investigators found that the perioperative risk of bleeding and arterial thromboembolism were low with this simplified strategy. The 30-day postoperative rate of major bleeding was 1.35% (95% CI, 0%-2.00%) in the apixaban cohort, 0.90% (95% CI, 0%-1.73%) in the dabigatran cohort, and 1.85% (95% CI, 0%-2.65%) in the rivaroxaban cohort. The rate of arterial thromboembolism was 0.16% (95% CI, 0%-0.48%) in the apixaban cohort, 0.60% (95% CI, 0%-1.33%) in the dabigatran cohort, and 0.37% (95% CI, 0%-0.82%) in the rivaroxaban cohort.

DOACs	Bleeding Risk	Arterial Thromboembolism
Apixaban	1.35	0.16
Dabigatran	0.90	0.60
Rivaroxaban	1.85	0.37