The perioperative management of new direct oral anticoagulants: a question without answers
New direct oral anticoagulant agents (DOAC) are currently licensed for thromboprophylaxis after hip and knee arthroplasty and for long-term prevention of thromboembolic events in non-valvular atrial fibrillation as well as treatment and secondary prophylaxis of venous thromboembolism. Some other med...
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| Veröffentlicht in: | Thrombosis and haemostasis 2013-09, Vol.110 (3), p.515-522 |
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| container_title | Thrombosis and haemostasis |
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| creator | Ferrandis, Raquel Castillo, Jordi Andrés, José de Gomar, Carmen Gómez-Luque, Aurelio Hidalgo, Francisco Llau, Juan V. Sierra, Pilar Torres, Luis M. |
| description | New direct oral anticoagulant agents (DOAC) are currently licensed for thromboprophylaxis after hip and knee arthroplasty and for long-term prevention of thromboembolic events in non-valvular atrial fibrillation as well as treatment and secondary prophylaxis of venous thromboembolism. Some other medical indications are emerging. Thus, anaesthesiologists are increasingly likely to encounter patients on these drugs who need elective or emergency surgery. Due to the lack of experience and data, the management of DOAC in the perioperative period is controversial. In this article, we review available information and recommendations regarding the periprocedural management of the currently most clinically developed DOAC, apixaban, dabigatran, and rivaroxaban. We discuss two trends of managing patients on DOAC for elective surgery. The first is stopping the DOAC 1–5 days before surgery (depending on the drug, patient and bleeding risk) without bridging. The second is stopping the DOAC 5 days preoperatively and bridging with low-molecular-weight heparin. The management of patients on DOAC needing emergency surgery is also reviewed. As no data exist for the use of haemostatic products for the reversal of the anticoagulant effect in these cases, rescue treatment recommendations are proposed. |
| doi_str_mv | 10.1160/TH12-11-0868 |
| format | Article |
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Some other medical indications are emerging. Thus, anaesthesiologists are increasingly likely to encounter patients on these drugs who need elective or emergency surgery. Due to the lack of experience and data, the management of DOAC in the perioperative period is controversial. In this article, we review available information and recommendations regarding the periprocedural management of the currently most clinically developed DOAC, apixaban, dabigatran, and rivaroxaban. We discuss two trends of managing patients on DOAC for elective surgery. The first is stopping the DOAC 1–5 days before surgery (depending on the drug, patient and bleeding risk) without bridging. The second is stopping the DOAC 5 days preoperatively and bridging with low-molecular-weight heparin. The management of patients on DOAC needing emergency surgery is also reviewed. As no data exist for the use of haemostatic products for the reversal of the anticoagulant effect in these cases, rescue treatment recommendations are proposed.</description><identifier>ISSN: 0340-6245</identifier><identifier>EISSN: 2567-689X</identifier><identifier>DOI: 10.1160/TH12-11-0868</identifier><identifier>PMID: 23846475</identifier><identifier>CODEN: THHADQ</identifier><language>eng</language><publisher>Stuttgart: Schattauer Verlag für Medizin und Naturwissenschaften</publisher><subject><![CDATA[Administration, Oral ; Aged ; Anesthesiology ; anticoagulants ; Anticoagulants - administration & dosage ; Anticoagulants - chemistry ; Apixaban ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Benzimidazoles - administration & dosage ; beta-Alanine - administration & dosage ; beta-Alanine - analogs & derivatives ; Biological and medical sciences ; Blood coagulation. Blood cells ; Dabigatran ; Female ; Fundamental and applied biological sciences. 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Some other medical indications are emerging. Thus, anaesthesiologists are increasingly likely to encounter patients on these drugs who need elective or emergency surgery. Due to the lack of experience and data, the management of DOAC in the perioperative period is controversial. In this article, we review available information and recommendations regarding the periprocedural management of the currently most clinically developed DOAC, apixaban, dabigatran, and rivaroxaban. We discuss two trends of managing patients on DOAC for elective surgery. The first is stopping the DOAC 1–5 days before surgery (depending on the drug, patient and bleeding risk) without bridging. The second is stopping the DOAC 5 days preoperatively and bridging with low-molecular-weight heparin. The management of patients on DOAC needing emergency surgery is also reviewed. As no data exist for the use of haemostatic products for the reversal of the anticoagulant effect in these cases, rescue treatment recommendations are proposed.</description><subject>Administration, Oral</subject><subject>Aged</subject><subject>Anesthesiology</subject><subject>anticoagulants</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - chemistry</subject><subject>Apixaban</subject><subject>Arthroplasty, Replacement, Hip</subject><subject>Arthroplasty, Replacement, Knee</subject><subject>Benzimidazoles - administration & dosage</subject><subject>beta-Alanine - administration & dosage</subject><subject>beta-Alanine - analogs & derivatives</subject><subject>Biological and medical sciences</subject><subject>Blood coagulation. Blood cells</subject><subject>Dabigatran</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>haemorrhage</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hemorrhage - prevention & control</subject><subject>Hemostasis</subject><subject>Heparin, Low-Molecular-Weight - therapeutic use</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Molecular and cellular biology</subject><subject>Morpholines - therapeutic use</subject><subject>Patient Safety</subject><subject>perioperative</subject><subject>Perioperative Period</subject><subject>Platelet diseases and coagulopathies</subject><subject>Pyrazoles - therapeutic use</subject><subject>Pyridones - therapeutic use</subject><subject>Review Article</subject><subject>Rivaroxaban</subject><subject>Thiophenes - therapeutic use</subject><subject>Thromboembolism - prevention & control</subject><subject>thrombosis</subject><issn>0340-6245</issn><issn>2567-689X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqtkU2L1TAUhoMoznV051q6caXVpB9p4k4GdYQBF15BBAmn6ck0Q9tcc1Iv_ntT7jiu3LlJzoGH9yVPGHsq-CshJH-9vxRVKUTJlVT32K5qZVdKpb_eZzteN7yUVdOesUdEN5wL2ej2ITuratXIpmt37Nt-xOKA0Yd8QPI_sZhhgWuccUlFcMWCx2LwEW3eIkwFLMnbANfrlCd6U0DxY0VKPizF0acxrCkjdMRIj9kDBxPhk9v7nH15_25_cVleffrw8eLtVWlboVOphVJD1yjUg6paBM37quulxrpzfTV0NTgYoKtcL6RwvdUOBKKUljshWyHrc_bylGtjIIrozCH6GeIvI7jZFJlNUZ7Mpijjz074Ye1nHO7gP04y8PwWALIwuQiL9fSX62THldp6X5y4NPqsy9yENS75of-q_X6iyY6QEqwY7yLTGMPcB8otsAxmBJwDJdh2T7SioQNaD5PJX7OSjf6QjNC6qg2N4WjGNE85__P_z69_Ayksw64</recordid><startdate>20130901</startdate><enddate>20130901</enddate><creator>Ferrandis, Raquel</creator><creator>Castillo, Jordi</creator><creator>Andrés, José de</creator><creator>Gomar, Carmen</creator><creator>Gómez-Luque, Aurelio</creator><creator>Hidalgo, Francisco</creator><creator>Llau, Juan V.</creator><creator>Sierra, Pilar</creator><creator>Torres, Luis M.</creator><general>Schattauer Verlag für Medizin und Naturwissenschaften</general><general>Schattauer GmbH</general><general>Schattauer</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20130901</creationdate><title>The perioperative management of new direct oral anticoagulants: a question without answers</title><author>Ferrandis, Raquel ; Castillo, Jordi ; Andrés, José de ; Gomar, Carmen ; Gómez-Luque, Aurelio ; Hidalgo, Francisco ; Llau, Juan V. ; Sierra, Pilar ; Torres, Luis M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c519t-9188d748e9d825ea90b27b69e37fb2d73afada72fb161fbc9fa1ee66c0f165163</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Administration, Oral</topic><topic>Aged</topic><topic>Anesthesiology</topic><topic>anticoagulants</topic><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - chemistry</topic><topic>Apixaban</topic><topic>Arthroplasty, Replacement, Hip</topic><topic>Arthroplasty, Replacement, Knee</topic><topic>Benzimidazoles - administration & dosage</topic><topic>beta-Alanine - administration & dosage</topic><topic>beta-Alanine - analogs & derivatives</topic><topic>Biological and medical sciences</topic><topic>Blood coagulation. Blood cells</topic><topic>Dabigatran</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>haemorrhage</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Hemorrhage - prevention & control</topic><topic>Hemostasis</topic><topic>Heparin, Low-Molecular-Weight - therapeutic use</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Molecular and cellular biology</topic><topic>Morpholines - therapeutic use</topic><topic>Patient Safety</topic><topic>perioperative</topic><topic>Perioperative Period</topic><topic>Platelet diseases and coagulopathies</topic><topic>Pyrazoles - therapeutic use</topic><topic>Pyridones - therapeutic use</topic><topic>Review Article</topic><topic>Rivaroxaban</topic><topic>Thiophenes - therapeutic use</topic><topic>Thromboembolism - prevention & control</topic><topic>thrombosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferrandis, Raquel</creatorcontrib><creatorcontrib>Castillo, Jordi</creatorcontrib><creatorcontrib>Andrés, José de</creatorcontrib><creatorcontrib>Gomar, Carmen</creatorcontrib><creatorcontrib>Gómez-Luque, Aurelio</creatorcontrib><creatorcontrib>Hidalgo, Francisco</creatorcontrib><creatorcontrib>Llau, Juan V.</creatorcontrib><creatorcontrib>Sierra, Pilar</creatorcontrib><creatorcontrib>Torres, Luis M.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferrandis, Raquel</au><au>Castillo, Jordi</au><au>Andrés, José de</au><au>Gomar, Carmen</au><au>Gómez-Luque, Aurelio</au><au>Hidalgo, Francisco</au><au>Llau, Juan V.</au><au>Sierra, Pilar</au><au>Torres, Luis M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The perioperative management of new direct oral anticoagulants: a question without answers</atitle><jtitle>Thrombosis and haemostasis</jtitle><addtitle>Thromb Haemost</addtitle><date>2013-09-01</date><risdate>2013</risdate><volume>110</volume><issue>3</issue><spage>515</spage><epage>522</epage><pages>515-522</pages><issn>0340-6245</issn><eissn>2567-689X</eissn><coden>THHADQ</coden><abstract>New direct oral anticoagulant agents (DOAC) are currently licensed for thromboprophylaxis after hip and knee arthroplasty and for long-term prevention of thromboembolic events in non-valvular atrial fibrillation as well as treatment and secondary prophylaxis of venous thromboembolism. Some other medical indications are emerging. Thus, anaesthesiologists are increasingly likely to encounter patients on these drugs who need elective or emergency surgery. Due to the lack of experience and data, the management of DOAC in the perioperative period is controversial. In this article, we review available information and recommendations regarding the periprocedural management of the currently most clinically developed DOAC, apixaban, dabigatran, and rivaroxaban. We discuss two trends of managing patients on DOAC for elective surgery. The first is stopping the DOAC 1–5 days before surgery (depending on the drug, patient and bleeding risk) without bridging. The second is stopping the DOAC 5 days preoperatively and bridging with low-molecular-weight heparin. The management of patients on DOAC needing emergency surgery is also reviewed. As no data exist for the use of haemostatic products for the reversal of the anticoagulant effect in these cases, rescue treatment recommendations are proposed.</abstract><cop>Stuttgart</cop><pub>Schattauer Verlag für Medizin und Naturwissenschaften</pub><pmid>23846475</pmid><doi>10.1160/TH12-11-0868</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0340-6245 |
| ispartof | Thrombosis and haemostasis, 2013-09, Vol.110 (3), p.515-522 |
| issn | 0340-6245 2567-689X |
| language | eng |
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| source | MEDLINE; Thieme Connect Journals |
| subjects | Administration, Oral Aged Anesthesiology anticoagulants Anticoagulants - administration & dosage Anticoagulants - chemistry Apixaban Arthroplasty, Replacement, Hip Arthroplasty, Replacement, Knee Benzimidazoles - administration & dosage beta-Alanine - administration & dosage beta-Alanine - analogs & derivatives Biological and medical sciences Blood coagulation. Blood cells Dabigatran Female Fundamental and applied biological sciences. Psychology haemorrhage Hematologic and hematopoietic diseases Hemorrhage - prevention & control Hemostasis Heparin, Low-Molecular-Weight - therapeutic use Humans Male Medical sciences Molecular and cellular biology Morpholines - therapeutic use Patient Safety perioperative Perioperative Period Platelet diseases and coagulopathies Pyrazoles - therapeutic use Pyridones - therapeutic use Review Article Rivaroxaban Thiophenes - therapeutic use Thromboembolism - prevention & control thrombosis |
| title | The perioperative management of new direct oral anticoagulants: a question without answers |
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