Weekday to Stop DOAC from Date of Surgery – ACTPeriOp

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Weekday to Stop DOAC Pre-Op

Dates are easily miscalculated, confused or forgotten. This calculator helps quickly check which day of the week (Friday etc) should be the last dose

Date of Surgery

Weekday of last dose can be calculated if Procedure Date provided

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Day -1

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Day -2

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Day -3

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Day -4

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Day -5

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Day -6

	Creatinine Clearance > 50ml/min²
	Period to Withhold Anticoagulant Before Surgery
	Low Risk of Surgical Bleeding	High Risk of Surgical Bleeding	Neuraxial Procedure
Rivaroxaban	Withhold 24 hours (Last dose Day -2, ie )	Withhold 2-3 Days (Last dose Day -3 or Day -4, ie or )	Withhold 3 Days (Last dose Day -4, ie )
Dabigatran	CrCl ≥ 80: Withhold 24 hours (Last dose Day -2, ie ) CrCl 50-80: Withhold 24-48 hours (Last dose Day -2 or Day -3, ie or )	CrCl ≥ 80: Withhold 2 Days (Last dose Day -3, ie ) CrCl 50-80: Withhold 2-3 Days (Last dose Day -3 or Day -4, ie or )	CrCl ≥ 80: Withhold 3 Days (Last dose Day -4, ie ) CrCl 50-80: Withhold 4 Days (Last dose Day -5, ie )
Apixaban	Withhold 24 hours (Last dose Day -2, ie )	Withhold 2-3 Days (Last dose Day -3 or Day -4, ie or )	Withhold 3 Days (Last dose Day -4, ie )

	Creatinine Clearance 30-49ml/min³
	Period to Withhold Anticoagulant Before Surgery
	Low Risk of Surgical Bleeding	High Risk of Surgical Bleeding	Neuraxial Procedure
Rivaroxaban	Withhold 48 hours (Last dose Day -3, ie )	Withhold 3 Days (Last dose Day -4, ie )	Withhold 3 Days (Last dose Day -4, ie )
Dabigatran	Withhold 2-3 days (Last dose Day -3 to Day -4, ie or )	Withhold 4 Days (Last dose Day -5, ie )	Withhold 5 Days (Last dose Day -6, ie )
Apixaban	Withhold 2 days (Last dose Day -3, ie )	Withhold 3 Days (Last dose Day -4, ie )	Withhold 4 Days (Last dose Day -5, ie )

	Creatinine Clearance > 50ml/min⁴
	Period to Withhold Anticoagulant Before Surgery
	Low Risk of Surgical Bleeding	High Risk of Surgical Bleeding	Neuraxial Procedure
Rivaroxaban	Withhold 24 hours (Last dose Day -2)	Withhold 2-3 Days (Last dose Day -3 or Day -4)	Withhold 3 Days (Last dose Day -4)
Dabigatran	CrCl ≥ 80: Withhold 24 hours (Last dose Day -2) CrCl 50-80: Withhold 24-48 hours (Last dose Day -2 or Day -3)	CrCl ≥ 80: Withhold 2 Days (Last dose Day -3) CrCl 50-80: Withhold 2-3 Days (Last dose Day -3 or Day -4)	CrCl ≥ 80: Withhold 3 Days (Last dose Day -4) CrCl 50-80: Withhold 4 Days (Last dose Day -5)
Apixaban	Withhold 24 hours (Last dose Day -2)	Withhold 2-3 Days (Last dose Day -3 or Day -4)	Withhold 3 Days (Last dose Day -4)

	Creatinine Clearance 30-49ml/min⁵
	Period to Withhold Anticoagulant Before Surgery
	Low Risk of Surgical Bleeding	High Risk of Surgical Bleeding	Neuraxial Procedure
Rivaroxaban	Withhold 48 hours (Last dose Day -3)	Withhold 3 Days (Last dose Day -4)	Withhold 3 Days (Last dose Day -4)
Dabigatran	Withhold 2-3 days (Last dose Day -3 to Day -4)	Withhold 4 Days (Last dose Day -5)	Withhold 5 Days (Last dose Day -6)
Apixaban	Withhold 2 days (Last dose Day -3)	Withhold 3 Days (Last dose Day -4)	Withhold 4 Days (Last dose Day -5)

Creatinine Clearance > 50ml/min⁶
Period to Withhold Anticoagulant Before Surgery
Rivaroxaban
Low Risk of Surgical Bleeding	Withhold 24 hours (Last dose Day -2)
High Risk of Surgical Bleeding	Withhold 2-3 Days (Last dose Day -3 or Day -4)
Neuraxial Procedure	Withhold 3 Days (Last dose Day -4)

Dabigatran
Low Risk of Surgical Bleeding	CrCl ≥ 80: Withhold 24 hours (Last dose Day -2) CrCl 50-80: Withhold 24-48 hours (Last dose Day -2 or Day -3)
High Risk of Surgical Bleeding	CrCl ≥ 80: Withhold 2 Days (Last dose Day -3) CrCl 50-80: Withhold 2-3 Days (Last dose Day -3 or Day -4)
Neuraxial Procedure	CrCl ≥ 80: Withhold 3 Days (Last dose Day -4) CrCl 50-80: Withhold 4 Days (Last dose Day -5)

Apixaban
Low Risk of Surgical Bleeding	Withhold 24 hours (Last dose Day -2)
High Risk of Surgical Bleeding	Withhold 2-3 Days (Last dose Day -3 or Day -4)
Neuraxial Procedure	Withhold 3 Days (Last dose Day -4)

Creatinine Clearance 30-49ml/min⁷
Period to Withhold Anticoagulant Before Surgery
Rivaroxaban
Low Risk of Surgical Bleeding	Withhold 48 hours (Last dose Day -3)
High Risk of Surgical Bleeding	Withhold 3 Days (Last dose Day -4)
Neuraxial Procedure	Withhold 3 Days (Last dose Day -4)

Dabigatran
Low Risk of Surgical Bleeding	Withhold 2-3 days (Last dose Day -3 to Day -4)
High Risk of Surgical Bleeding	Withhold 4 Days (Last dose Day -5)
Neuraxial Procedure	Withhold 5 Days (Last dose Day -6)

Apixaban
Low Risk of Surgical Bleeding	Withhold 2 days (Last dose Day -3)
High Risk of Surgical Bleeding	Withhold 3 Days (Last dose Day -4)
Neuraxial Procedure	Withhold 4 Days (Last dose Day -5)

Creatinine Clearance > 50ml/min⁸
Period to Withhold Anticoagulant Before Surgery
Rivaroxaban
Low Risk of Surgical Bleeding	Withhold 24 hours (Last dose Day -2, ie )
High Risk of Surgical Bleeding	Withhold 2-3 Days (Last dose Day -3 or Day -4, ie or )
Neuraxial Procedure	Withhold 3 Days (Last dose Day -4, ie )

Dabigatran
Low Risk of Surgical Bleeding	CrCl ≥ 80: Withhold 24 hours (Last dose Day -2, ie ) CrCl 50-80: Withhold 24-48 hours (Last dose Day -2 or Day -3, ie or )
High Risk of Surgical Bleeding	CrCl ≥ 80: Withhold 2 Days (Last dose Day -3, ie ) CrCl 50-80: Withhold 2-3 Days (Last dose Day -3 or Day -4, ie or )
Neuraxial Procedure	CrCl ≥ 80: Withhold 3 Days (Last dose Day -4, ie ) CrCl 50-80: Withhold 4 Days (Last dose Day -5, ie )

Apixaban
Low Risk of Surgical Bleeding	Withhold 24 hours (Last dose Day -2, ie )
High Risk of Surgical Bleeding	Withhold 2-3 Days (Last dose Day -3 or Day -4, ie or )
Neuraxial Procedure	Withhold 3 Days (Last dose Day -4, ie )

Creatinine Clearance 30-49ml/min⁹
Period to Withhold Anticoagulant Before Surgery
Rivaroxaban
Low Risk of Surgical Bleeding	Withhold 48 hours (Last dose Day -3, ie )
High Risk of Surgical Bleeding	Withhold 3 Days (Last dose Day -4, ie )
Neuraxial Procedure	Withhold 3 Days (Last dose Day -4, ie )

Dabigatran
Low Risk of Surgical Bleeding	Withhold 2-3 days (Last dose Day -3 to Day -4, ie or )
High Risk of Surgical Bleeding	Withhold 4 Days (Last dose Day -5, ie )
Neuraxial Procedure	Withhold 5 Days (Last dose Day -6, ie )

Apixaban
Low Risk of Surgical Bleeding	Withhold 2 days (Last dose Day -3, ie )
High Risk of Surgical Bleeding	Withhold 3 Days (Last dose Day -4, ie )
Neuraxial Procedure	Withhold 4 Days (Last dose Day -5, ie )

References

Guidelines on perioperative management of anticoagulant and antiplatelet agents - NSW Clinical Excellence Commission 2018
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