Apixaban : Perioperative

1.    Stop apixaban two days before the procedure (off apixaban for one day before the procedure and the day of the procedure).

2.    No bridging.

3.    Resume apixaban the day after the procedure, after at least 24 hours have elapsed when hemostasis secured. If the patient requires polyp removal, delay resumption of apixaban for one to two more days.

4.    Before resume the treatment, PT, APTT, signs and symptoms of bleeding should be monitored and assessed. If there is changes in these parameters delay resumption of apixaban at least 48 hours after the procedure.

5.    Bleeding risk should be assessed before doing any procedure. Table below shows the risk of bleeding for certain procedures :

                                                                                                                         

References

1.   Uptodate.com

2.  Guideline for patients receiving apixaban(eliquis) requiring emergency surgery or treatment for haemorrhage. (Nottingham University Hospital, NHS)