NOACs: Planned Elective procedure
Step 1: Bleeding risk
Dental extractions (1–3 teeth), periodontal surgery, implant positioning, subgingival scaling/cleaning
Cataract or glaucoma intervention
Endoscopy without biopsy or resection
Superficial surgery (e.g. abscess incision; minor dermatologic excisions, skin biopsy)
Pacemaker or ICD implantation (except complex procedures)
Electrophysiological study or catheter ablation (except complex procedures)
Routine elective coronary/peripheral artery intervention (except complex procedures)
Intramuscular injection (e.g. vaccination)
Cardiac surgery
Peripheral arterial revascularization surgery (e.g. aortic aneurysm repair, vascular bypass)
Complex invasive cardiological interventions, including lead extraction, (epicardial)
VT ablation, chronic total occlusion PCI etc.
Neurosurgery Spinal or epidural anaesthesia; lumbar diagnostic puncture
Complex endoscopy (e.g. multiple/large polypectomy, ERCP with sphincterotomy etc.)
Abdominal surgery (incl. liver biopsy)
Thoracic surgery
Major urologic surgery/biopsy (incl. kidney)
Extracorporeal shockwave lithotripsy
Major orthopaedic surgery
Step 2: Drugs and Calculate CrCl
Drug
Age
Body weight
Serum creatinine
Sex
No need for heparin bridging.
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References
Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, Oldgren J, Reinecke H, Roldan-Schilling V, Rowell N, Sinnaeve P, Vanassche T, Potpara T, Camm AJ, Heidbüchel H; External reviewers. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021 Oct 9;23(10):1612-1676.