A 74-year-old on apixaban 5 mg twice daily for atrial fibrillation (eGFR 70 mL/min/1.73 m2) is scheduled for elective open colectomy (high bleeding ri...

Question

A 74-year-old on apixaban 5 mg twice daily for atrial fibrillation (eGFR 70 mL/min/1.73 m2) is scheduled for elective open colectomy (high bleeding risk). What is the appropriate perioperative plan?

Accepted Answer

Stop apixaban 48-72 hours before without heparin bridging; resume 48-72 hours post-op if hemostasis is secure

Answer

Continue apixaban through surgery

Answer

Stop apixaban 24 hours before and bridge with therapeutic LMWH

Answer

Switch to warfarin 1 week pre-op to target INR 2-3

Answer

Stop apixaban 7 days prior and avoid resumption for 2 weeks

Perioperative Anticoagulation — MRCP Part 1 MCQ

A 74-year-old on apixaban 5 mg twice daily for atrial fibrillation (eGFR 70 mL/min/1.73 m2) is scheduled for elective open colectomy (high bleeding risk). What is the appropriate perioperative plan?