Medications
Apixaban (Eliquis) Before Surgery
Apixaban is a direct oral anticoagulant (DOAC). It clears the body faster than warfarin, so the stop time is shorter — but it depends on your kidneys and the surgery.
Quick answer
Why it matters
Apixaban blocks clotting factor Xa and wears off in a day or two, so a short, well-timed pause usually gives safe surgery without leaving you unprotected for long.
Because the drug is partly cleared by the kidneys, reduced kidney function means it lingers longer — so your exact stop time depends on your kidney blood test and how much bleeding the surgery involves.
Do not stop without instruction
What to ask your doctor
- Exactly how many hours before surgery do I stop apixaban?
- What is my kidney function, and does it change the timing?
- When do I restart it afterward?
- Do I need any bridging (usually not)?
Red flags — call your team
Red flags — call your team
- Kidney disease or reduced kidney function
- A previous blood clot, stroke, or mechanical valve
- Unusual bleeding before surgery
References
- American Society of Regional Anesthesia (ASRA) — anticoagulation guidelines.
- American College of Cardiology (ACC) — periprocedural DOAC management. acc.org
Frequently asked questions
How long before surgery do I stop Eliquis?
Anesthesia (ASRA) guidance is about 72 hours (3 days), longer if your kidney function is reduced — particularly if a spinal or epidural is planned. Some general surgery may use a shorter hold, so follow your team's exact timing.
Do I need bridging with Eliquis?
Usually not — DOACs like apixaban clear quickly, so most patients don't need heparin bridging.