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Table 3 Examples of bleeding risk stratification for invasive procedures

From: Perioperative management of patients on direct oral anticoagulants

Minimal risk of bleeding or feasible with on-therapy levels of direct oral anticoagulantsa Low to moderate risk of bleeding High risk of bleeding
Tooth extraction: 1 to 3 teeth
Simple endoscopy without biopsy
Superficial surgery (e.g. abscess incision or minor dermatologic procedures (small superficial excision)
Cataract procedure
Double J stent insertion
Endoscopy with simple biopsy
Prostate or bladder biopsy
Coronary angiography
Simple abdominal hernia repair
Anal surgery
Gynecologic surgery: simple total laparoscopic hysterectomy
Orthopedic surgery: hand surgery, arthroscopy
Pace-maker or cardioverter-defibrillator implantationb
Neuraxial anesthesia
Intracranial surgery
Thoracic surgery
Cardiac surgery
Complex abdominal or gynecological cancer surgery
Major orthopedic surgery
Ear/Nose/Throat complex cancer surgery or specific surgery requiring good hemostasis (e.g. cochlear implant or thyroid surgery)
Liver and kidney biopsy
Transurethral prostate or bladder resection
Extracorporeal shockwave lithotripsy
Infected pace maker lead extraction (increased risk of cardiac tamponade)
Robotic surgery
  1. aWe suggest realizing these procedures at trough levels of direct oral anticoagulants (e.g. avoiding the intake the morning of the procedure)
  2. bAwaiting results of BRUISECONTROL-2 trial (NCT01675076) to decide whether device procedures can be safely realized on direct oral anticoagulants