Hematology · LIVE

Perioperative DOAC interruption

Perioperative DOAC

Return published elective perioperative DOAC hold and resume day counts from Douketis 2022 (PAUSE-style implementation considerations, recommendations 22-25) given the INN, procedure bleed-risk category, and dabigatran CrCl when required.

LIVE $0.005 USDC GET /api/calc/periop_doac

Markdown: /docs/periop-doac.md · Canonical: https://magentlab.com/docs/periop-doac

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

Return published elective perioperative DOAC hold and resume day counts from Douketis 2022 (PAUSE-style implementation considerations, recommendations 22-25) given the INN, procedure bleed-risk category, and dabigatran CrCl when required.

When to use

When an agent needs the Douketis 2022 elective DOAC interruption table for apixaban, rivaroxaban, edoxaban, or dabigatran and must not apply a warfarin 5-day hold, heparin bridging, or an urgent-surgery pathway.

When not to use

• Not a medical device. Not a prescription and not an anticoagulation order. A licensed clinician remains responsible for timing around an elective procedure.
• Elective surgery or procedure only. Not urgent or emergency surgery. Not a warfarin or VKA 5-day interruption.
• Recommendation 26 suggests against heparin bridging of a DOAC. heparin_bridge is always false. magent does not order heparin.
• magent does not assay CrCl. The caller assigns CrCl for dabigatran. CrCl must be absent for apixaban, rivaroxaban, and edoxaban.
• INN names only (apixaban, rivaroxaban, edoxaban, dabigatran). Not a diagnosis of bleed risk; the caller assigns low_to_moderate or high.

Formula

Douketis 2022 PAUSE-style elective DOAC interruption (recommendations 22-25): apixaban/rivaroxaban/edoxaban hold 1 day (low_to_moderate) or 2 days (high); dabigatran CrCl>=50 same 1/2; dabigatran CrCl<50 hold 2 (low_to_moderate) or 4 (high); resume 1 day after low_to_moderate or 2 days after high; heparin_bridge always false (recommendation 26)

Citation

Title

Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline

Authors

Douketis JD, Spyropoulos AC, Murad MH, et al.

Source

Chest. 2022;162(5):e207-e243

DOI

10.1016/j.chest.2022.07.025

Worked example

Also searched as

• perioperative DOAC
• DOAC interruption
• PAUSE DOAC
• Douketis perioperative
• elective DOAC hold
• dabigatran CrCl hold
• ACCP antithrombotic
• perioperative apixaban

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/periop_doac?doac=apixaban&bleed_risk=low_to_moderate

Full URL: https://api.magentlab.com/api/calc/periop_doac?doac=apixaban&bleed_risk=low_to_moderate

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/periop_doac?doac=apixaban&bleed_risk=low_to_moderate"

Parameters

Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

POST /api/calc/periop_doac Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 PREVIEW

• 1 to 25 items. Each item uses the same keys as the GET query parameters.
• POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
• The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
• HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
• Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
• x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "bleed_risk": "low_to_moderate",
      "doac": "apixaban"
    },
    {
      "bleed_risk": "low_to_moderate",
      "doac": "apixaban"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/periop_doac",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Douketis JD, Spyropoulos AC, Murad MH, et al.",
        "doi": "10.1016/j.chest.2022.07.025",
        "id": "douketis-2022",
        "pmid": "35964704",
        "source": "Chest. 2022;162(5):e207-e243",
        "title": "Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline"
      },
      "formula": "periop_doac",
      "formula_expression": "Douketis 2022 PAUSE-style elective DOAC interruption (recommendations 22-25): apixaban/rivaroxaban/edoxaban hold 1 day (low_to_moderate) or 2 days (high); dabigatran CrCl>=50 same 1/2; dabigatran CrCl<50 hold 2 (low_to_moderate) or 4 (high); resume 1 day after low_to_moderate or 2 days after high; heparin_bridge always false (recommendation 26)",
      "criteria": [
        {
          "value": "apixaban",
          "factor": "doac",
          "met": true
        },
        {
          "value": "low_to_moderate",
          "factor": "high_bleed_risk",
          "met": false
        },
        {
          "factor": "dabigatran",
          "met": false
        },
        {
          "factor": "dabigatran_crcl_lt_50",
          "met": false
        }
      ],
      "bleed_risk": "low_to_moderate",
      "doac": "apixaban",
      "heparin_bridge": false,
      "hold_days_before": 1,
      "resume_days_after": 1,
      "total_pre_post_days": 2
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Douketis JD, Spyropoulos AC, Murad MH, et al.",
        "doi": "10.1016/j.chest.2022.07.025",
        "id": "douketis-2022",
        "pmid": "35964704",
        "source": "Chest. 2022;162(5):e207-e243",
        "title": "Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline"
      },
      "formula": "periop_doac",
      "formula_expression": "Douketis 2022 PAUSE-style elective DOAC interruption (recommendations 22-25): apixaban/rivaroxaban/edoxaban hold 1 day (low_to_moderate) or 2 days (high); dabigatran CrCl>=50 same 1/2; dabigatran CrCl<50 hold 2 (low_to_moderate) or 4 (high); resume 1 day after low_to_moderate or 2 days after high; heparin_bridge always false (recommendation 26)",
      "criteria": [
        {
          "value": "apixaban",
          "factor": "doac",
          "met": true
        },
        {
          "value": "low_to_moderate",
          "factor": "high_bleed_risk",
          "met": false
        },
        {
          "factor": "dabigatran",
          "met": false
        },
        {
          "factor": "dabigatran_crcl_lt_50",
          "met": false
        }
      ],
      "bleed_risk": "low_to_moderate",
      "doac": "apixaban",
      "heparin_bridge": false,
      "hold_days_before": 1,
      "resume_days_after": 1,
      "total_pre_post_days": 2
    }
  ]
}

Response

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Douketis JD, Spyropoulos AC, Murad MH, et al.",
    "doi": "10.1016/j.chest.2022.07.025",
    "id": "douketis-2022",
    "pmid": "35964704",
    "source": "Chest. 2022;162(5):e207-e243",
    "title": "Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline"
  },
  "formula": "periop_doac",
  "formula_expression": "Douketis 2022 PAUSE-style elective DOAC interruption (recommendations 22-25): apixaban/rivaroxaban/edoxaban hold 1 day (low_to_moderate) or 2 days (high); dabigatran CrCl>=50 same 1/2; dabigatran CrCl<50 hold 2 (low_to_moderate) or 4 (high); resume 1 day after low_to_moderate or 2 days after high; heparin_bridge always false (recommendation 26)",
  "criteria": [
    {
      "value": "apixaban",
      "factor": "doac",
      "met": true
    },
    {
      "value": "low_to_moderate",
      "factor": "high_bleed_risk",
      "met": false
    },
    {
      "factor": "dabigatran",
      "met": false
    },
    {
      "factor": "dabigatran_crcl_lt_50",
      "met": false
    }
  ],
  "bleed_risk": "low_to_moderate",
  "doac": "apixaban",
  "heparin_bridge": false,
  "hold_days_before": 1,
  "resume_days_after": 1,
  "total_pre_post_days": 2
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

Related tools

• DOAC Score — Compute the Aggarwal 2023 DOAC Score from age, CrCl or eGFR, and caller-assigned Table 2 flags for patients with atrial fibrillation on a DOAC.
• HAS-BLED — Compute the HAS-BLED bleeding-risk score from discrete clinical flags.

Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

• HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
• exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
• HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
• Execution is timeout-bounded and concurrency-capped.
• Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.