Perioperative Anticoagulant Use for Surgery Evaluation -2 (PAUSE-2) Study Patients Receiving a Direct Oral Anticoagulant (DOACs-Dabigatran, Rivaroxaban, Apixaban or Edoxaban) and Needing Elective High-Bleed-Risk Surgery or an Invasive Procedure

This study is developing a simple, standardized plan for safely stopping and restarting blood thinners (called DOACs — direct oral anticoagulants) around the time of surgery. People who take these medications for atrial fibrillation or blood clots face a tricky balance: stopping too early increases clot risk, while stopping too late increases bleeding risk. This study tests a standardized timing protocol. **You may be eligible if...** - You are 18 or older - You take a DOAC (apixaban, dabigatran, rivaroxaban, or edoxaban) for atrial fibrillation, atrial flutter, or a prior blood clot (DVT or pulmonary embolism) - You are scheduled for an elective (non-emergency) surgery or procedure that carries a high bleeding risk, or any surgery requiring spinal or epidural anesthesia **You may NOT be eligible if...** - You take blood thinners for an unusual clot location (such as brain, gut, or arm veins) - You are on a low-dose DOAC regimen used specifically for preventing recurrent blood clots - Your surgery is urgent or emergent Talk to your doctor to see if this trial is right for you.