Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting:...

Area of Science:

• Pharmacology
• Cardiology
• Hematology

Background:

• Non-vitamin K oral anticoagulants (NOACs) are increasingly prescribed for atrial fibrillation and venous thromboembolism.
• Clinical practice faces challenges in managing bleeding and perioperative risks associated with NOACs.
• Current recommendations often rely on expert opinion due to sparse clinical trial data.

Purpose of the Study:

• To address the uncertainty in managing patients on NOACs experiencing bleeding or requiring perioperative care.
• To highlight critical factors and available interventions for NOAC reversal.

Main Methods:

• Review of clinical practice challenges and available data on NOAC management.
• Discussion of factors influencing NOAC management, including time of ingestion and renal function.
• Identification of available reversal agents and their limitations.

Main Results:

• Lack of specific reversal agents for oral factor Xa inhibitors in the US.
• Idarucizumab is available for dabigatran reversal.
• Prothrombin concentrate may be considered for life-threatening bleeding.
• Accurate assessment of NOACs' last intake time and renal function is crucial.

Conclusions:

• Healthcare institutions need multidisciplinary protocols for NOAC reversal and perioperative management.
• Standardized protocols can mitigate risks and improve patient outcomes.
• Further research is needed to address gaps in NOAC management guidelines.