When should Apixaban be discontinued prior to moderate or major surgery?

Apixaban is a direct oral anticoagulant (DOAC) used for preventing thromboembolic events. When preparing a patient for moderate to major surgery, it is crucial to consider the pharmacokinetics and the bleeding risk associated with the medication.

The correct timeframe to discontinue Apixaban is generally 48 hours prior to the surgery. This recommendation is based on the drug's half-life and the need to ensure that the anticoagulant effects have adequately diminished to reduce the risk of perioperative bleeding. Since Apixaban has a half-life of approximately 12 hours in healthy individuals, ceasing its use 48 hours before surgery allows for sufficient clearance, thereby minimizing any potential complications associated with bleeding during and after the surgical procedure.

Other options for discontinuation periods, such as 24 hours or 1 day, might not provide enough time for the drug to fully clear from the system in all patients, particularly those with renal impairment, which can prolong the drug's effects. The 3-day option could be unnecessarily prolonged, potentially increasing the risk of thromboembolic events in patients who require uninterrupted anticoagulation management. Thus, the 48-hour discontinuation period strikes a balance between safely managing the risks of both bleeding and