CC BY-NC-ND 4.0 · Thromb Haemost 2022; 122(03): 329-335
DOI: 10.1055/a-1715-5960
Position Paper

Management of DOAC in Patients Undergoing Planned Surgery or Invasive Procedure: Italian Federation of Centers for the Diagnosis of Thrombotic Disorders and the Surveillance of the Antithrombotic Therapies (FCSA) Position Paper

1   Research Center on Thromboembolic Disorders and Antithrombotic Therapies, ASST Lariana, University of Insubria, Como, Italy
Daniela Poli
2   Thrombosis Center, ‘Careggi’ Hospital, Florence, Italy
3   Thrombosis and Haemostasis Unit, University of Cagliari, Cagliari, Italy
Antonio Ciampa
4   Haemostasis Center, ‘Moscati’ Hospital, Avellino, Italy
5   Thrombosis and Haemostasis Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
6   Ob/Gyn Department, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
Cesare Manotti
7   Haemostasis Center, Hospital of Parma, Parma, Italy
Marco Moia
8   Haemophilia and Thrombosis Center, IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
Vincenzo Toschi
9   Department of Haematology and Blood Transfusion and Thrombosis Center, Santi Paolo e Carlo Hospital, Milan, Italy
Alberto Tosetto
10   Hemophilia and Thrombosis Center, Hematology Department, San Bortolo Hospital, Vicenza, Italy
Sophie Testa
11   Haemostasis and Thrombosis Center, ASST Cremona, Cremona, Italy
Scientific Reviewer Committee
› Author Affiliations
Funding None.


Patients on anticoagulant treatment are constantly increasing, with an estimated prevalence in Italy of 2% of the total population. About a quarter of the anticoagulated patients require temporary cessation of direct oral anticoagulants (DOACs) or vitamin K antagonists for a planned intervention within 2 years from anticoagulation inception. Several clinical issues about DOAC interruption remain unanswered: many questions are tentatively addressed daily by thousands of physicians worldwide through an experience-based balancing of thrombotic and bleeding risks. Among possible valuable answers, the Italian Federation of Centers for the diagnosis of thrombotic disorders and the Surveillance of the Antithrombotic therapies (FCSA) proposes some experience-based suggestions and expert opinions. In particular, FCSA provides practical guidance on the following issues: (1) multiparametric assessment of thrombotic and bleeding risks based on patients' individual and surgical risk factor, (2) testing of prothrombin time, activated partial thromboplastin time, and DOAC plasma levels before surgery or invasive procedure, (3) use of heparin, (4) restarting of full-dose DOAC after high risk bleeding surgery, (5) practical nonpharmacological suggestions to manage patients perioperatively. Finally, FCSA suggests creating a multidisciplinary “anticoagulation team” with the aim to define the optimal perioperative management of anticoagulation.

Publication History

Received: 04 August 2021

Accepted: 02 December 2021

Publication Date:
07 December 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany