Key result
A 24-hour preoperative suspension of apixaban resulted in high residual anti-factor Xa levels, whereas a 48-hour suspension allowed safe surgery without complications.
Why the study?
There is a lack of robust evidence to guide the perioperative management of apixaban, raising concerns about hemorrhagic risk if coagulation normalization is not confirmed.
Does suspending apixaban 24 hours before elective surgery prevent residual anticoagulation?
Case Report (n=1)
No
Does suspending apixaban 24 hours before elective surgery prevent residual anticoagulation?
Routine suspension of apixaban 24 hours before elective surgery may not be sufficient to clear anticoagulation, suggesting a potential role for anti-factor Xa level testing.
Answers are grounded in this paper and cite their sources.
Questions adequacy of 24-hour apixaban suspension preoperatively; case report leaves open role for anti-Xa testing.
Direct oral anticoagulants, such as apixaban, have a predictable dose-response and few interactions with other drugs and food; hence, they do not require routine coagulation monitoring. We report a woman on long-term treatment with apixaban undergoing elective surgery. Although apixaban was suspended 24 h before, we noticed residual anticoagulation just prior the intervention. Given the lack of robust evidence to guide perioperative management of apixaban, it could be an increased risk of hemorrhagic complications if normalization of the coagulation system is not checked. We propose anti-factor Xa levels' determination in every patient on chronic therapy with apixaban before programmed surgery.
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Monteserín-Matesanz et al. (2019) conducted a case report in Long-term apixaban therapy requiring elective surgery (n=1). Preoperative suspension of apixaban was evaluated on Residual anticoagulant effect (anti-factor Xa levels). A 24-hour preoperative suspension of apixaban resulted in high residual anti-factor Xa levels, whereas a 48-hour suspension allowed safe surgery without complications.
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