Perioperative management of patients on direct oral anticoagulants

Research output: Contribution to journalReview article

Abstract

Direct oral anticoagulants (DOACs) have been licensed worldwide for several years for various indications. Each year, 10-15% of patients on oral anticoagulants will undergo an invasive procedure and expert groups have issued several guidelines on perioperative management in such situations. The perioperative guidelines have undergone numerous updates as clinical experience of emergency management has increased and perioperative studies including measurement of residual anticoagulant levels have been published. The high inter-patient variability of DOAC plasma levels has challenged the traditional recommendation that perioperative DOAC interruption should be based only on the elimination half-life of DOACs, especially before invasive procedures carrying a high risk of bleeding. Furthermore, recent publications have highlighted the potential danger of heparin bridging use when DOACs are stopped before an invasive procedure. As antidotes are progressively becoming available to manage severe bleeding or urgent procedures in patients on DOACs, accurate laboratory tests have become the standard to guide their administration and their actions need to be well understood by clinicians. This review aims to provide a systematic approach to managing patients on DOACs, based on recent updates of various perioperative guidance, and highlighting the advantages and limits of recommendations based on pharmacokinetic properties and laboratory tests.

Original languageEnglish
Article number14
Pages (from-to)14
JournalThrombosis journal
Volume15
Issue number1
DOIs
Publication statusPublished - 15 May 2017
Externally publishedYes

Fingerprint

Anticoagulants
Guidelines
Hemorrhage
Antidotes
Half-Life
Heparin
Emergencies
Pharmacokinetics

Keywords

  • Anticoagulants
  • Blood coagulation test
  • Emergency care
  • Invasive procedures
  • Perioperative period
  • Spinal anesthesia

Cite this

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title = "Perioperative management of patients on direct oral anticoagulants",
abstract = "Direct oral anticoagulants (DOACs) have been licensed worldwide for several years for various indications. Each year, 10-15{\%} of patients on oral anticoagulants will undergo an invasive procedure and expert groups have issued several guidelines on perioperative management in such situations. The perioperative guidelines have undergone numerous updates as clinical experience of emergency management has increased and perioperative studies including measurement of residual anticoagulant levels have been published. The high inter-patient variability of DOAC plasma levels has challenged the traditional recommendation that perioperative DOAC interruption should be based only on the elimination half-life of DOACs, especially before invasive procedures carrying a high risk of bleeding. Furthermore, recent publications have highlighted the potential danger of heparin bridging use when DOACs are stopped before an invasive procedure. As antidotes are progressively becoming available to manage severe bleeding or urgent procedures in patients on DOACs, accurate laboratory tests have become the standard to guide their administration and their actions need to be well understood by clinicians. This review aims to provide a systematic approach to managing patients on DOACs, based on recent updates of various perioperative guidance, and highlighting the advantages and limits of recommendations based on pharmacokinetic properties and laboratory tests.",
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Perioperative management of patients on direct oral anticoagulants. / Dubois, Virginie; Dincq, Anne-Sophie; Douxfils, Jonathan; Ickx, Brigitte; Samama, Charles-Marc; Dogné, Jean-Michel; Gourdin, Maximilien; Chatelain, Bernard; Mullier, François; Lessire, Sarah.

In: Thrombosis journal, Vol. 15, No. 1, 14, 15.05.2017, p. 14.

Research output: Contribution to journalReview article

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T1 - Perioperative management of patients on direct oral anticoagulants

AU - Dubois, Virginie

AU - Dincq, Anne-Sophie

AU - Douxfils, Jonathan

AU - Ickx, Brigitte

AU - Samama, Charles-Marc

AU - Dogné, Jean-Michel

AU - Gourdin, Maximilien

AU - Chatelain, Bernard

AU - Mullier, François

AU - Lessire, Sarah

PY - 2017/5/15

Y1 - 2017/5/15

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KW - Anticoagulants

KW - Blood coagulation test

KW - Emergency care

KW - Invasive procedures

KW - Perioperative period

KW - Spinal anesthesia

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