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[Perioperative coagulation management during ascending aorta replacement on apixaban]

C Dumps1, E Halbeck2, J Schimpf2

  • 1Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland. christian.dumps@klinikum-augsburg.de.

Der Anaesthesist
|July 6, 2016
PubMed

Insights

Direct oral anticoagulants (DOACs) are effective alternatives to vitamin K antagonists but pose challenges in emergency surgery due to a lack of specific antidotes. This case study details managing apixaban during urgent ascending aorta replacement following dissection.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Vascular Surgery

Background:

  • Direct oral anticoagulants (DOACs) offer alternatives to vitamin K antagonists for thromboembolism prevention and treatment.
  • Specific antidotes for most DOACs, except dabigatran, are not yet available.
  • Perioperative management of DOACs is challenging in emergency surgeries with high bleeding risks.

Observation:

  • This case study focuses on a patient undergoing emergency ascending aorta replacement after aortic dissection.
  • The patient was administered apixaban, a direct oral anticoagulant.
  • Perioperative coagulation management strategies were employed.

Findings:

  • The study details the successful perioperative management of a patient on apixaban undergoing complex aortic surgery.
  • It highlights the challenges and strategies involved in managing bleeding risks associated with DOACs in emergency settings.
  • This case demonstrates a potential approach to perioperative care in similar high-risk scenarios.

Implications:

  • This case provides insights into managing patients on direct oral anticoagulants requiring urgent surgical intervention.
  • It underscores the need for established protocols for perioperative coagulation management of DOACs.
  • Further research and clinical guidelines are needed to address the perioperative challenges posed by DOACs.

Keywords:
AntidotesAortic dissectionAscending aortic replacementDirect oral anticoagulantsPerioperative coagulation management

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