Table 1 Key properties8 of the direct oral anticoagulants which are currently available for use in the UK

From: Managing direct oral anticoagulants in patients undergoing dentoalveolar surgery

Pharmacokinetic parameter Dabigatran Apixaban Edoxaban Rivaroxaban
Bioavailability (%) 6 70 62 80
Peak onset (h) 1.5–2 3–4 1–2 2–4
Elimination half-life (h)* 12–14 12 10–14 7–11
Manufacturers' recommendations on discontinuation before surgical procedure If possible, dabigatran should be discontinued at least 24 hours before invasive or surgical procedures. In patients at higher risk of bleeding or in major surgery where complete haemostasis may be required, consider stopping dabigatran 2–4 days before surgery. Clearance of dabigatran in patients with renal insufficiency may take longer. This should be considered in advance of any procedures.
Dabigatran etexilate should be restarted after the invasive procedure or surgical intervention as soon as possible provided the clinical situation allows and adequate haemostasis has been established.
Patients at risk for bleeding or patients at risk of overexposure, notably patients with moderate renal impairment (CrCL 30–50 mL/min), should be treated with caution.
Apixaban should be stopped 48 hours before a procedure with a moderate or high risk of bleeding and 24 hours before a procedure with a low risk of bleeding. If anticoagulation must be discontinued to reduce the risk of bleeding with surgical or other procedures, edoxaban should be stopped as soon as possible and preferably at least 24 hours before the procedure. If an invasive procedure or surgical intervention is required, rivaroxaban 20 mg should be stopped at least 24 hours before the intervention, if possible.
Manufacturers' recommendations on restarting post-surgical procedure   Apixaban should be restarted after the invasive procedure or surgical intervention as soon as possible provided the clinical situation allows and adequate haemostasis has been established. Edoxaban should be restarted after the surgical or other procedures as soon as adequate haemostasis has been established, noting that the time to onset of the edoxaban anticoagulant therapeutic effect is 1–2 hours. Rivaroxaban should be restarted as soon as possible after the invasive procedure or surgical intervention provided the clinical situation allows and adequate haemostasis has been established as determined by the treating physician.
  1. *assumes no renal impairment