Perioperative Management of Patients Receiving Novel Oral Anticoagulants

A 62-year-old woman with permanent non-valvular atrial fibrillation (AF) is scheduled for colonic resection of a cancer diagnosed two weeks ago during a routine colonoscopy. At the moment, there is no active bleeding and no evidence of metastasis. Her medical history includes arterial hypertension, diabetes, and a previous stroke two years ago while on treatment with warfarin. Ongoing medications are as follows: apixaban 5 mg/BID, ramipril 10 mg/QD, and multiple daily insulin injections. Her CHA2DS2-VASc score is 5, and her HAS-BLED score is 3. Blood tests performed during preoperative evaluation were within normal ranges, with the exception of serum creatinine 1.15 mg/dL (creatinine clearance 56 mL/min, estimated glomerular filtration rate (eGFR) 51 mL/min/1.73 m2) and hemoglobin 11.8 g/dL. The surgeon requesting the cardiac consultation has a specific question regarding the management of anticoagulation. He states that colonic resection is a procedure at high risk for bleeding.

According to current evidence, which of the following describes how to manage the patient's anticoagulation treatment during the perioperative period?

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