[Direct oral anticoagulant management for elective surgery : key points in the context of city medical practice].

Practices regarding the interruption, substitution, and restart of direct oral anticoagulants (DOACs) during the perioperative period have constantly evolved since the commercialization of those medications. This may lead to uncertainties regarding their adequate management among practitioners, particularly outside the hospital. We propose a review of recent reference publications and guidelines defining DOAC management during the pre- and postoperative period for elective surgery, with the goal of providing a pratical guide for practitioners outside the hospital, including general practitioners and pharmacists. After classifying the bleeding risk of surgery or interventional procedure, we indicate how to proceed. When the bleeding risk is minimal, DOACs should be stopped 24 hours before the procedure (i.e. no intake on the day of the procedure). When the risk is moderate or high, the last intake should occur 60 to 72 hours before the procedure (4 days for dabigatran), without any bridging with low molecular weight heparins. In patients with renal insufficiency, these delays should be extended, specifically for dabigatran.