Douketis JD, Spyropoulos AC, Duncan J, et al. - Via a cohort study with 3,007 individuals who have atrial fibrillation (AF) and using apixaban, researchers examined the safety of a standardized perioperative direct oral anticoagulant (DOAC) management approach. There were 1,257 patients in the apixaban cohort, 668 in the dabigatran cohort, and 1,082 in the rivaroxaban cohort. There were 1,007 individuals who had a high–bleeding-risk procedure. The 30-day postoperative rate of major bleeding was 1.35%, 0.90% and, 1.85% in the apixaban cohort, the dabigatran cohort, and the rivaroxaban cohort, respectively. The rate of arterial thromboembolism in the apixaban cohort, the dabigatran cohort, and the rivaroxaban cohort 0.16%, 0.60% and, 0.37%, respectively. The rates of major bleeding were 2.96% and 2.95% in the apixaban cohort and in the rivaroxaban cohort, respectively, in individuals with a high–bleeding-risk procedure. A perioperative management approach lacking heparin bridging or coagulation function testing was correlated with low rates of major bleeding and arterial thromboembolism in individuals with AF who had DOAC therapy interruption for elective surgery or procedure. Rates of major bleeding were less than 2%, and the rates of stroke were less than 1% 30 days after surgery.