Table 8

Recommendations for timing of discontinuation of anticoagulation for elective surgery

DrugTiming of discontinuation
Warfarin5 days
Direct thrombin inhibitors (dabigatran)CrCl ≥50 mL/min: 1–2 days
CrCl <50 mL/min: 3–5 days
CrCl (mL/min)Bleed risk: lowBleed risk: high (days)
≥5024 hours2-3
30–502 days2-3
<302–4 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
 AspirinHigh-CV risk/minor: continue
Low CV/high-bleed risk: 7–10 days
 Clopidogrel5 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.