Perioperative management of patients on direct oral anticoagulants

Résultats de recherche: Contribution à un journal/une revueArticle de revue

Résumé

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.

langueAnglais
Pages14
journalThrombosis journal
Volume15
Les DOIs
étatPublié - 2017
Modification externeOui

Empreinte digitale

Anticoagulants
Guidelines
Hemorrhage
Antidotes
Half-Life
Heparin
Emergencies
Pharmacokinetics

mots-clés

    Citer ceci

    @article{3e5d2c0c314248ac9761930277adbccb,
    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.",
    keywords = "Journal Article, Review",
    author = "Virginie Dubois and Anne-Sophie Dincq and Jonathan Douxfils and Brigitte Ickx and Charles-Marc Samama and Jean-Michel Dogn{\'e} and Maximilien Gourdin and Bernard Chatelain and Fran{\cc}ois Mullier and Sarah Lessire",
    year = "2017",
    doi = "10.1186/s12959-017-0137-1",
    language = "English",
    volume = "15",
    pages = "14",
    journal = "Thrombosis journal",
    issn = "1477-9560",
    publisher = "BioMed Central",

    }

    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.

    Dans: Thrombosis journal, Vol 15, 2017, p. 14.

    Résultats de recherche: Contribution à un journal/une revueArticle de revue

    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

    PY - 2017

    Y1 - 2017

    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 - Journal Article

    KW - Review

    U2 - 10.1186/s12959-017-0137-1

    DO - 10.1186/s12959-017-0137-1

    M3 - Review article

    VL - 15

    SP - 14

    JO - Thrombosis journal

    T2 - Thrombosis journal

    JF - Thrombosis journal

    SN - 1477-9560

    ER -