Structured Approach to Perioperative Management of Atrial Fibrillation in Patients Who Take DOACs

Because direct-acting oral anticoagulants (DOACs) have short half-lives, withholding these agents for only a few days should be possible when DOAC-treated patients require interruption of their anticoagulation around the time of elective surgery. In this prospective cohort study, investigators designed a structured approach to DOAC interruption for 3007 adults (mean age, 72) with atrial fibrillation (AF) who were scheduled for elective surgery and who were receiving long-term therapy with apixaban, dabigatran, or rivaroxaban. Patients were excluded if their creatinine clearance was <25 mL/minute with apixaban or <30 mL/minute with dabigatran or rivaroxaban. DOACs were held for 1 day before surgical procedures with low risk for bleeding and …