Periprocedural Anticoagulation Management For Nonoperating Room Anesthesia Procedures: A Clinical Guide

Area of Science:

• Anesthesiology
• Pharmacology
• Patient Safety

Background:

• Non-operating room anesthesia (NORA) poses unique challenges due to limited preprocedural optimization and unfamiliarity with diverse settings.
• Managing patients on chronic oral anticoagulation in NORA settings is particularly complex, with variable bleeding risks.
• Physicians may lack familiarity with newer oral anticoagulants and their appropriate periprocedural management.

Purpose of the Study:

• To review common non-operating room procedures and their associated bleeding risks.
• To examine the pharmacokinetics of currently available oral anticoagulants.
• To outline periprocedural management options for patients on oral anticoagulation undergoing NORA.

Main Methods:

• Literature review of non-operating room procedures and bleeding risks.
• Analysis of pharmacokinetic profiles of oral anticoagulants.
• Synthesis of current guidelines and expert recommendations for periprocedural management.

Main Results:

• Bleeding risks in NORA vary significantly and differ from traditional surgical settings.
• A growing number of novel oral anticoagulants (NOACs) require specific management considerations.
• Periprocedural management strategies depend on the specific anticoagulant, procedure, and patient factors.

Conclusions:

• Anesthesiologists require updated knowledge on NORA procedures and oral anticoagulant management.
• Tailored periprocedural strategies are essential for optimizing patient safety in NORA.
• Further research may be needed to standardize management protocols for NOACs in NORA settings.