Table 4

Recommended Durations for Withholding DOACs Based on Procedural Bleed Risk and Estimated CrCl When There Are No Increased Patient Bleed Risk Factors

DabigatranApixaban, Edoxaban, or Rivaroxaban
CrCl, mL/min≥8050–7930–4915–29<15≥3015–29<15
Estimated drug half-life, h1315182730 (off dialysis)6–15Apixaban: 17
Edoxaban: 17
Rivaroxaban: 9
Apixaban: 17 (off dialysis)
Edoxaban: 10-17 (off dialysis)
Rivaroxaban: 13 (off dialysis)
Procedural bleed risk
Low≥24 h≥36 h≥48 h≥72 hNo data. Consider measuring dTT and/or withholding ≥96 h≥24 h≥36 hNo data. Consider measuring agent-specific anti Xa level and/or withholding ≥48 h
Uncertain, intermediate, or high≥48 h≥72 h≥96 h≥120 hNo data. Consider measuring dTT≥48 hNo data. Consider measuring agent-specific anti Xa level and/or withholding ≥72 h

NOTE: The duration for withholding is based upon the estimated DOAC half-life withholding times of 2 to 3 half-lives for low procedural bleeding risk and 4 to 5 drug half-lives for uncertain, intermediate, or high procedural bleeding risk (47–55).

CrCl = creatinine clearance; DOAC = direct-acting oral anticoagulant; dTT = dilute thrombin time.