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[Recommendations on use of direct oral anticoagulants in the perioperative period]

Juan V Llau1, Raquel Ferrandis, Jorge Castillo

  • 1Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Universidad Católica San Vicente Mártir, Valencia, España. juanvllau@gmail.com

Medicina Clinica
|March 19, 2013
PubMed

Insights

Managing direct oral anticoagulants (DOA) requires specific strategies due to their unique properties. This study outlines recommendations for perioperative and emergency management of these crucial anticoagulant medications.

Area of Science:

  • Pharmacology and Therapeutics
  • Cardiology
  • Anesthesiology

Context:

  • Direct oral anticoagulants (DOA) present management challenges due to lack of reversal agents and standardized monitoring.
  • Limited clinical experience with DOAs necessitates clear guidelines for perioperative and emergency care.
  • Increasing use of DOAs in clinical practice requires evidence-based management protocols.

Purpose:

  • To establish specific recommendations for the perioperative and emergency management of patients on direct oral anticoagulants (DOA).
  • To provide guidance on drug withdrawal timing and bridging therapy in elective surgery.
  • To outline strategies for managing acute hemorrhage related to DOAs.

Summary:

  • For elective surgery with normal renal function and low risk, discontinue DOAs 2 days prior. For higher risk, consider bridging with low molecular weight heparin starting 5 days before.
  • Prophylactic hemostatic drugs are not recommended in emergency surgery involving DOAs.
  • In acute DOA-related hemorrhage, evaluate prothrombin complex concentrate, fresh plasma, or factor VIIa, alongside general hemostatic measures.

Impact:

  • Provides clinicians with actionable guidelines for safe and effective management of patients on DOAs during surgical procedures and emergencies.
  • Aims to reduce perioperative bleeding complications and optimize thrombotic risk management.
  • Facilitates standardized care for patients requiring anticoagulation with DOAs, improving patient outcomes.

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