Exploring the Perioperative Use of DOACs, off the Beaten Track

Area of Science:

• Cardiology
• Pharmacology
• Perioperative Medicine

Background:

• Direct oral anticoagulants (DOACs) have largely replaced vitamin K antagonists (VKAs) due to improved efficacy, safety, and convenience.
• Increased DOAC utilization presents challenges in managing patients requiring surgical or interventional procedures.
• Perioperative anticoagulation management for DOAC users is a growing clinical concern.

Purpose of the Study:

• To provide a practical guide for clinicians on managing direct oral anticoagulants (DOACs) during the perioperative period.
• To address controversial issues and offer strategies for optimal patient care.
• To guide physicians in decision-making regarding DOAC discontinuation and resumption.

Main Methods:

• This narrative review synthesizes current literature and clinical guidelines.
• It focuses on evaluating patient-specific factors and procedural risks.
• A multidisciplinary approach is emphasized for perioperative management.

Main Results:

• Optimal perioperative management necessitates a comprehensive assessment of patient factors (age, stroke risk, bleeding history, renal/hepatic function, medications) and surgical considerations.
• Some procedures may allow for minimal or uninterrupted DOAC strategies, while others require temporary discontinuation.
• Individualized strategies are crucial for balancing thrombotic and bleeding risks.

Conclusions:

• Effective perioperative anticoagulation for DOAC patients requires careful, individualized planning.
• A multidisciplinary team approach is essential for successful management.
• This review aims to equip physicians with the knowledge to navigate these complex clinical scenarios.