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 Periodontology 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 |