Question

A 69-year-old woman with atrial fibrillation and previous stroke is scheduled for elective hip replacement. She is on a DOAC. According to perioperative anticoagulation principles, which strategy is generally appropriate for an elective high-bleeding-risk surgery with normal renal function?

Accepted Answer

Stop the DOAC 2-3 days before surgery without heparin bridging and restart postoperatively when haemostasis is secure

Answer

Continue the DOAC through surgery

Answer

Stop the DOAC 7 days before surgery and bridge with full-dose LMWH

Answer

Switch to warfarin and maintain INR 2-3 through surgery

Answer

Double the DOAC dose the night before surgery to prevent perioperative stroke

Practice question

A 69-year-old woman with atrial fibrillation and previous stroke is scheduled for elective hip replacement. She is on a DOAC. According to perioperative anticoagulation principles, which strategy is generally appropriate for an elective high-bleeding-risk surgery with normal renal function?