Apixaban Discontinuation Guidelines for Orbital Floor Fracture Repair

Pre-Surgery Considerations

For patients with normal or mildly impaired renal function, the last dose of apixaban should be 3 days before surgery for high bleeding risk procedures, and 2 days before surgery for low bleeding risk procedures, according to the American Society of Hematology 1, 2
For patients with moderate renal impairment, the last dose of apixaban should be 4 days before surgery for high bleeding risk procedures, and 3 days before surgery for low bleeding risk procedures, as recommended by the American Society of Hematology 1, 2
The American Academy of Ophthalmology considers orbital floor fracture repair a high bleeding risk procedure due to the proximity to critical structures and risk of retrobulbar hematoma 3

The American Academy of Ophthalmology recommends immediate repair of orbital floor fractures for muscle/tissue entrapment with oculocardiac reflex, "white-eyed blow-out fracture," or globe subluxation 4, 3
Repair within 2 weeks is recommended for symptomatic diplopia with positive forced ductions, large floor fractures, hypoglobus, or early enophthalmos, according to the American Academy of Ophthalmology 4, 3

The American Society of Hematology recommends assessing patient's renal function to determine appropriate discontinuation timeline for apixaban 1, 2
For patients with renal impairment, the discontinuation period for apixaban should be extended as outlined above, according to the American Society of Hematology 1, 2
The American College of Cardiology suggests resuming apixaban 2-3 days after surgery when adequate hemostasis has been established for high bleeding risk procedures like orbital floor repair 5, 6