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Perioperative DOAC management — RCPSC IM MCQ

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HardCardiologyPerioperative DOAC managementRCPSC IM

A 66-year-old taking apixaban 5 mg twice daily for atrial fibrillation is booked for colonoscopy with anticipated polypectomy. Creatinine clearance is 62 mL/min, the procedure is elective and there has been no recent stroke. What is the best peri-procedural plan?

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Correct answer: B — Interrupt apixaban without therapeutic heparin bridging

The best answer is “Interrupt apixaban without therapeutic heparin bridging”. Anticipated polypectomy warrants planned DOAC interruption, with timing based on bleeding risk and renal clearance. The short offset and onset of apixaban make therapeutic bridging unnecessary in this setting; uninterrupted dosing, hurried warfarin conversion and cancellation create avoidable risk.

Reference: Thrombosis Canada, DOACs: perioperative management: https://thrombosiscanada.ca/hcp/practice/clinical_guides?guideID=PERIOPERATIVEMANAGEMENTOFPATIE&language=en-ca