Conform ghidului, Edoxabanul, rivaroxabanul, apixabanul si dabigatranul se intrerup 2 zile inainte de chirurgia majora, nu mai mult. Apare o singura mentiune la dabigatran, la pacientii cu boala cronica de rinichi, cu clearance scazut la creatinina, unde se intrerupe 4 zile, dar la majoritatea pacientilor 2 zile este suficient. De aceea nu se mai face inlocuirea cu heparina injectabila/ enoxaparina pe aceasta perioada. Cum se traduce asta? La 2 zile dupa ce pacientul a luat ultima doza, poate fi pe masa de operatie. Sursa de unde am luat tabelul, este ghidul de practică clinică publicat de American College of Cardiology (ACC), American Heart Association (AHA), American College of Chest Physicians (ACCP) și Heart Rhythm Society (HRS) privind diagnosticul și managementul fibrilației atriale din 2023, cea mai serioasa sursa in domeniu. „2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation”.

How long should NOACs be stopped before surgery, if required?

*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.

†The 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. The 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.