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Table 8 Pharmacokinetic and pharmacodynamic characteristics of oral anticoagulants

Warfarin Phenprocoumon Apixaban Dabigatran Edoxaban Rivaroxaban

Target (type of blockade) VKORC1 VKORC1 FXa FIIa FXa FXa Application Oral Oral Oral Oral Oral Oral Time to Cmax 2–6 h 1.52 h + 1.52 3–4 h 1.25–3 h 1–2 h 2–4 h Prodrug No No No Yes No No Bioavailability (%) .95 100 50 6.5 62 80–100 Drug interactions CYP2C9, CYP2C19,

CYP2C8, CYP2C18, CYP1A2, CYP3A4, vitamin K CYP2C9, CYP2C8,

vitamin K CYP3A4 inhibitors

or inductors, P-glycoprotein inhibitors or inductors P-glycoprotein

inhibitors or inductors P-glycoprotein

inhibitors CYP3A4 inhibitors

or inductors, P-glycoprotein inhibitors or inductors

Plasma half-life 36–48 h ≏100 h 12 h 12–14 h 6–11 h 7–11 h (11–13 h in

the elderly)

Duration of action after last dose ≏5 days ≏7 days 24 h 24 h 24 h 24 h Renal clearance of the active metabolite (%) Non-renal Non-renal 27 85 37–50 33 Dose regimen Adjusted

according to INR Adjusted according

to INR b.i.d. b.i.d. o.d. o.d./b.i.d. © ESC 2022

b.i.d., twice a day; Cmax, maximum serum concentration; FIIa, factor IIa; FXa, factor Xa; INR, International normalized ratio; LD, loading dose; NOAC, non-vitamin K antagonist oral anticoagulant; o.d., once a day; VKORC1, vitamin K epoxide reductase complex 1.

Table 9 Bleeding risk according to type of non-cardiac surgery

Surgery with minor bleeding risk Surgery with low bleeding risk (infrequent or with low clinical

impact) Surgery with high bleeding risk (frequent or with significant clinical

impact)

• Cataract or glaucoma procedure • Dental procedures: extractions (1–3 teeth), periodontal

surgery, implant positioning, endodontic (root canal) procedures, subgingival scaling/cleaning • Endoscopy without biopsy or resection • Superficial surgery (e.g. abscess incision, small skin excisions/ biopsy) • Abdominal surgery: cholecystectomy,

hernia repair, colon resection • Breast surgery • Complex dental procedures (multiple

tooth extractions) • Endoscopy with simple biopsy • Gastroscopy or colonoscopy with

simple biopsy • Large-bore needles procedures (e.g. bone marrow or lymph node biopsy) • Non-cataract ophthalmic surgery • Small orthopaedic surgery (foot, hand arthroscopy) • Abdominal surgery with liver biopsy,

extracorporeal shockwave lithotripsy • Extensive cancer surgery (e.g. pancreas, liver) • Neuraxial (spinal or epidural) anaesthesia • Neurosurgery (intracranial, spinal) • Major orthopaedic surgery • Procedures with vascular organ biopsy (kidney or prostate) • Reconstructive plastic surgery • Specific interventions (colon polypectomy,

lumbar puncture, endovascular aneurysm repair) • Thoracic surgery, lung resection surgery • Urological surgery (prostatectomy, bladder tumour resection) • Vascular surgery (e.g. AAA repair, vascular

bypass) © ESC 2022

AAA, abdominal aortic aneurysm. Adapted from Steffel et al.240 Downloaded from academic.oup.com/eurheartj/article/43/39/3826/6675076 by guest on 07 October 2026