Perioperative Anticoagulation: Frequently Asked Questions

Should I bridge DOACs?

No. DOACs are not bridged. If a patient is very high thrombosis risk, consult Hematology for rare exceptions rather than auto-bridging.

Who needs bridging on warfarin?

Only high-risk patients (e.g., certain mechanical valves, recent VTE, very high AF stroke risk). If CrCl <30, prefer UFH over LMWH for therapeutic bridging.

What INR should I aim for before surgery on warfarin?

INR <1.5 prior to the procedure; if ≥1.5 within 24–48 h of the case, correct or delay.

How do catheters affect timing?

• DOACs: no dosing while catheter is in place; earliest restart is removal + 24 h and later than baseline if needed.
• LMWH: earliest restart is removal + 4 h and later than baseline if needed.
• UFH infusion: earliest restart is removal + 1 h with normal aPTT, and later than baseline if needed.

Any neuraxial hard-stops?

Yes. Avoid neuraxial if renal function is poor with certain agents (e.g., dabigatran CrCl <30; apixaban CrCl <25; rivaroxaban/edoxaban CrCl <30).

When can I restart after surgery?

Only when hemostasis is secure. Low/mod risk ~12–24 h; high/neuraxial ~48–72 h (drug-class specific nuances apply). Use the calculator for patient-specific timestamps.

Have a scenario in mind? Generate a plan with the AnticoagPlanner calculator.

Sources

• MD Anderson. Peri-Procedure Anticoagulants, V8 (approved 07/15/2025).
• ASRA/Stanford institutional neuraxial catheter timing summaries.