JAMA Netw Open

Should factor Xa inhibitors be stopped for low bleeding-risk procedures?

February 14, 2025

Study details: The PERIXa* study was a prospective cohort study examining the safety of perioperative discontinuation of factor Xa inhibitors in 1,902 patients with afib undergoing elective procedures with minimal to low bleeding risk. Patients were categorized into three cohorts based on the type of procedure: endoscopy, dental, or ocular. Primary outcome was major bleeding, and the secondary outcome included a composite of thromboembolic events 30 days after the index procedure.

Results: Discontinuing factor Xa inhibitors perioperatively didn’t significantly increase the risk of major bleeding or thromboembolic events. The 30-day event rate of major bleeding was 0.1% (n = 2), and there were no composite thromboembolic events.

Clinical impact: The findings suggest that it’s generally safe to discontinue factor Xa inhibitors for patients with afib undergoing procedures with minimal to low bleeding risk.

* The PERIXa (Perioperative Factor Xa Inhibitor Discontinuation in Patients With Atrial Fibrillation Undergoing Minimal to Low Bleed Risk Procedures) protocol recommends administering the last dose of factor Xa inhibitor (i.e., apixaban, edoxaban, or rivaroxaban) 24 hours before the procedure and restarting treatment the next day.

Source:

Lee SR, et al; PERIXa Investigators. (2025, February 7). JAMA Netw Open. Perioperative Factor Xa Inhibitor Discontinuation for Patients Undergoing Procedures With Minimal or Low Bleeding Risk. https://pubmed.ncbi.nlm.nih.gov/39918817/