[Perioperative management of new oral anticoagulants]

Direct oral anticoagulants, anti-Xa and anti-IIa, are indicated in case of atrial fibrillation or venous thromboembolic disease. Annually, one in ten patients treated by anticoagulants required a scheduled or emergent invasive procedure. Short discontinuation before an invasive procedure may lead to incomplete elimination of the drug especially in case of renal insufficiency or drug-drug interactions. Before an invasive procedure with a moderate to high bleeding risk, a discontinuation of 5 days is proposed, most often without bridging with heparin. Before a procedure with a low bleeding risk, stopping direct anticoagulant 24 hours before the procedure is sufficient. In case of emergent surgery, it is proposed to delay surgery for at least one or two half-lives if possible. Prophylactic use of non-specific procoagulant drug is not recommended.