• Joan M Irizarry Alvarado, Emily K Carpenter, Daniela A Haehn, Natalia Chamorro Pareja, Ismael Carrillo-Martin, and Pedro Malavet.
• From the Department of Anesthesiology and Perioperative Medicine, Division of General Internal Medicine, and the Division of Allergy and Immunology, Mayo Clinic, Jacksonville, Florida, and Furman University, Greenville, South Carolina.
• South. Med. J. 2021 Jul 1; 114 (7): 442-444.

ObjectiveWe aimed to review recommendations for the postoperative resumption of direct oral anticoagulants (DOACs) and report complications 30 days postoperatively.MethodsWe retrospectively reviewed patients receiving DOAC therapy who underwent preoperative evaluations from January 1, 2015 through May 30, 2018. We noted days that DOAC therapy was withheld, postoperative time until resumption of the DOAC, and complications within 30 postoperative days.ResultsA total of 317 patients were included. Ten had complications. Complication rates among patients stratified by time to resumption were not significantly different, except for the deep vein thrombosis rate when DOACs were resumed after 72 hours (n = 2 [4.17%]; P = 0.02). The total time without DOACs did not affect the complication rates.ConclusionsWe suggest withholding DOACs for 48 to 72 hours before surgery and resuming them 48 to 72 hours after surgery, if safe. The interruption of therapy was not associated with an increase in thrombotic events for patients who resumed DOACs within 72 hours postoperatively. Patients who resumed DOACs after 72 hours postoperatively had a low rate of thrombotic complications.

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