[New oral anticoagulants in perioperative medicine]

Area of Science:

• Pharmacology and Hematology
• Anesthesiology and Perioperative Medicine

Context:

• New oral anticoagulants (NOACs) are increasingly used as alternatives to vitamin K antagonists for various indications.
• Perioperative management of patients on NOACs presents significant challenges across medical disciplines.
• Indications include deep vein thrombosis prophylaxis, therapeutic anticoagulation, and stroke prophylaxis in atrial fibrillation.

Purpose:

• To outline the perioperative challenges associated with NOACs.
• To emphasize the need for early anesthesiologist evaluation for non-emergency surgeries.
• To highlight the importance of an interdisciplinary approach for managing emergency procedures.

Summary:

• NOACs inhibit factor Xa or factor IIa, posing challenges for perioperative care.
• Non-emergency surgery requires early anesthesiologist consultation for optimal scheduling and bridging strategies.
• Emergency procedures necessitate individualized risk assessment (bleeding vs. urgency) and may involve drug serum level determination.

Impact:

• Informed perioperative strategies for patients on NOACs can mitigate bleeding risks.
• Facilitates safer surgical planning and execution for patients requiring anticoagulation.
• Guides management of coagulopathy during emergency procedures, including the use of blood products and factor concentrates.