[The new oral anticoagulants in surgery]

We can estimated the probability of developing thromboembolic disease and consequently prescribed antithrombotic measures to patients undergoing surgery. The anticoagulants carry the risk of abnormal bleeding, which can sometimes be fatal. Recently, this concept changed with the development of new drugs that retain their antithrombotic activity but decrease their anticoagulant effect; other advantages are: route of administration, predictable bioavailability (generally do not require monitoring), and little interaction with food and other drugs. The most representative are direct factor Xa inhibitors like apixaban and rivaroxaban as well as factor IIa inhibitors, such as dabigatran. They had been evaluated in patients undergoing hip or knee surgery in comparison with low molecular weight heparins; in general they had better results in efficacy and similar results in safety. Trials are now underway to evaluate their use in other surgical and nonsurgical environments. Today, the surgical patient is older and has comorbidities, such as atrial fibrillation, prosthetic valves, diabetes mellitus, hypertension, and other chronic diseases. These patients need be protected from thrombosis with low bleeding risk. New antithrombotic drugs offer a margin of safety and maintain efficacy; therefore, they constitute an advantage over classical anticoagulant drugs. We highlight concepts related with the need for thromboprophylaxis and the new antithrombotic medication in a surgical context.