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DOAC Low Bleeding Risk Procedures — FRCA Final MCQ

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ModeratePreoperative AssessmentDOAC Low Bleeding Risk ProceduresFRCA Final

A 60-year-old woman (ASA III) with metastatic ovarian cancer has massive ascites causing respiratory compromise. She requires paracentesis. She is on rivaroxaban 20 mg daily. The procedure is considered low bleeding risk. According to BSH/BCSH guidance, should rivaroxaban be withheld?

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Correct answer: E — No – low bleeding risk procedures can proceed on therapeutic anticoagulation

According to BSH guidance and NICE CG141, low bleeding risk procedures (including paracentesis, diagnostic lumbar puncture, joint aspiration, and superficial biopsies) can generally proceed without interruption of anticoagulation (including DOACs and warfarin at therapeutic doses). The bleeding risk from the procedure is low and is outweighed by the thromboembolic risk of stopping anticoagulation. For moderate-to-high bleeding risk procedures (neuraxial block, major surgery), DOACs must be withheld. Timing depends on the specific DOAC and renal function.

Reference: BSH – 2022 – Perioperative anticoagulant management; NICE – 2020 – CG141 VTE management