TY - JOUR
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
N1 - Publisher Copyright:
© 2017 The Author(s).
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2017/5/15
Y1 - 2017/5/15
N2 - 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.
AB - 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.
KW - Anticoagulants
KW - Blood coagulation test
KW - Emergency care
KW - Invasive procedures
KW - Perioperative period
KW - Spinal anesthesia
UR - http://www.scopus.com/inward/record.url?scp=85019178434&partnerID=8YFLogxK
UR - http://thrombosisjournal.biomedcentral.com/articles/10.1186/s12959-017-0137-1
UR - http://www.mendeley.com/research/perioperative-management-patients-direct-oral-anticoagulants
U2 - 10.1186/s12959-017-0137-1
DO - 10.1186/s12959-017-0137-1
M3 - Review article
C2 - 28515674
SN - 1477-9560
VL - 15
SP - 14
JO - Thrombosis journal
JF - Thrombosis journal
IS - 1
M1 - 14
ER -