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Perioperative anticoagulation — MCCQE Part 1 MCQ

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ModeratePre-op AssessmentPerioperative anticoagulationMCCQE Part 1

74-year-old man on apixaban for atrial fibrillation presents with planned elective hernia repair. Renal function is normal and thrombotic risk is not extreme. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Hold apixaban for an interval based on bleeding risk and renal function without routine bridging

Hold apixaban for an interval based on bleeding risk and renal function without routine bridging is best because DOAC interruption is based on procedure bleeding risk and kidney function; bridging is usually unnecessary. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. Bridging applies to selected warfarin patients, not most DOAC users.

Reference: Thrombosis Canada perioperative anticoagulation guide