Perioperative management of target-specific oral anticoagulants

Area of Science:

• Pharmacology
• Cardiology
• Surgical Management

Background:

• Target-specific oral anticoagulants (TSOACs) are increasingly used, offering advantages over vitamin K antagonists.
• Managing TSOACs perioperatively poses challenges due to difficulties in monitoring anticoagulant effect and lack of reversal agents.

Purpose of the Study:

• To outline perioperative management strategies for patients on TSOACs undergoing invasive procedures.
• To provide guidance on timing of TSOAC cessation and resumption, and the potential need for bridging therapy.

Main Methods:

• Review of pharmacokinetic and pharmacodynamic data of TSOACs.
• Extrapolation from existing literature and expert opinion on perioperative anticoagulation.
• Consideration of individual patient bleeding and thrombosis risks, procedure type, and drug clearance.

Main Results:

• Perioperative plans for TSOACs necessitate individualized risk assessment.
• Timing of drug cessation and resumption is crucial for minimizing procedural complications.
• Bridging therapy may be considered based on risk stratification.

Conclusions:

• Developing tailored perioperative strategies for TSOACs is essential for patient safety.
• Evidence-based guidelines are emerging, but management often relies on pharmacokinetic principles and clinical judgment.
• Further research is needed to refine perioperative TSOAC management.