Direct oral anticoagulants, such as apixaban, have a predictable dose-response and few interactions with other drugs and food; hence, they do not require routine coagulation monitoring. We report a woman on long-term treatment with apixaban undergoing elective surgery. Although apixaban was suspended 24 h before, we noticed residual anticoagulation just prior the intervention. Given the lack of robust evidence to guide perioperative management of apixaban, it could be an increased risk of hemorrhagic complications if normalization of the coagulation system is not checked. We propose anti-factor Xa levels' determination in every patient on chronic therapy with apixaban before programmed surgery.
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