Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendations
Indications of non-vitamin K antagonist oral anticoagulants (NOACs), consisting of two types: direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitor (rivaroxaban, apixaban, and edoxaban), have expanded over the last few years. Accordingly, increasing number of patients presenting for...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Korean Society of Anesthesiologists
2020-04-01
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| Series: | Anesthesia and Pain Medicine |
| Subjects: | |
| Online Access: | http://www.anesth-pain-med.org/upload/pdf/apm-2020-15-2-133.pdf |
| _version_ | 1827946155707727872 |
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| author | Kwang-Sub Kim Jong Wook Song Sarah Soh Young-Lan Kwak Jae-Kwang Shim |
| author_facet | Kwang-Sub Kim Jong Wook Song Sarah Soh Young-Lan Kwak Jae-Kwang Shim |
| author_sort | Kwang-Sub Kim |
| collection | DOAJ |
| description | Indications of non-vitamin K antagonist oral anticoagulants (NOACs), consisting of two types: direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitor (rivaroxaban, apixaban, and edoxaban), have expanded over the last few years. Accordingly, increasing number of patients presenting for surgery are being exposed to NOACs, despite the fact that NOACs are inevitably related to increased perioperative bleeding risk. This review article contains recent clinical evidence-based up-to-date recommendations to help set up a multidisciplinary management strategy to provide a safe perioperative milieu for patients receiving NOACs. In brief, despite the paucity of related clinical evidence, several key recommendations can be drawn based on the emerging clinical evidence, expert consensus, and predictable pharmacological properties of NOACs. In elective surgeries, it seems safe to perform high-bleeding risk surgeries 2 days after cessation of NOAC, regardless of the type of NOAC. Neuraxial anesthesia should be performed 3 days after cessation of NOACs. In both instances, dabigatran needs to be discontinued for an additional 1 or 2 days, depending on the decrease in renal function. NOACs do not require a preoperative heparin bridge therapy. Emergent or urgent surgeries should preferably be delayed for at least 12 h from the last NOAC intake (better if > 24 h). If surgery cannot be delayed, consider using specific reversal agents, which are idarucizumab for dabigatran and andexanet alfa for rivaroxaban, apixaban, and edoxaban. If these specific reversal agents are not available, consider using prothrombin complex concentrates. |
| first_indexed | 2024-03-13T10:54:41Z |
| format | Article |
| id | doaj.art-ca8bc43ab7e04961863f22b41c58160d |
| institution | Directory Open Access Journal |
| issn | 1975-5171 2383-7977 |
| language | English |
| last_indexed | 2024-03-13T10:54:41Z |
| publishDate | 2020-04-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Anesthesia and Pain Medicine |
| spelling | doaj.art-ca8bc43ab7e04961863f22b41c58160d2023-05-17T05:33:43ZengKorean Society of AnesthesiologistsAnesthesia and Pain Medicine1975-51712383-79772020-04-0115213314210.17085/apm.2020.15.2.1331012Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendationsKwang-Sub Kim0Jong Wook Song1Sarah Soh2Young-Lan Kwak3Jae-Kwang Shim4 Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, KoreaIndications of non-vitamin K antagonist oral anticoagulants (NOACs), consisting of two types: direct thrombin inhibitor (dabigatran) and direct factor Xa inhibitor (rivaroxaban, apixaban, and edoxaban), have expanded over the last few years. Accordingly, increasing number of patients presenting for surgery are being exposed to NOACs, despite the fact that NOACs are inevitably related to increased perioperative bleeding risk. This review article contains recent clinical evidence-based up-to-date recommendations to help set up a multidisciplinary management strategy to provide a safe perioperative milieu for patients receiving NOACs. In brief, despite the paucity of related clinical evidence, several key recommendations can be drawn based on the emerging clinical evidence, expert consensus, and predictable pharmacological properties of NOACs. In elective surgeries, it seems safe to perform high-bleeding risk surgeries 2 days after cessation of NOAC, regardless of the type of NOAC. Neuraxial anesthesia should be performed 3 days after cessation of NOACs. In both instances, dabigatran needs to be discontinued for an additional 1 or 2 days, depending on the decrease in renal function. NOACs do not require a preoperative heparin bridge therapy. Emergent or urgent surgeries should preferably be delayed for at least 12 h from the last NOAC intake (better if > 24 h). If surgery cannot be delayed, consider using specific reversal agents, which are idarucizumab for dabigatran and andexanet alfa for rivaroxaban, apixaban, and edoxaban. If these specific reversal agents are not available, consider using prothrombin complex concentrates.http://www.anesth-pain-med.org/upload/pdf/apm-2020-15-2-133.pdfanticoagulantsblood loss, surgicalemergencynon-vitamin k antagonistreversal |
| spellingShingle | Kwang-Sub Kim Jong Wook Song Sarah Soh Young-Lan Kwak Jae-Kwang Shim Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendations Anesthesia and Pain Medicine anticoagulants blood loss, surgical emergency non-vitamin k antagonist reversal |
| title | Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendations |
| title_full | Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendations |
| title_fullStr | Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendations |
| title_full_unstemmed | Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendations |
| title_short | Perioperative management of patients receiving non-vitamin K antagonist oral anticoagulants: up-to-date recommendations |
| title_sort | perioperative management of patients receiving non vitamin k antagonist oral anticoagulants up to date recommendations |
| topic | anticoagulants blood loss, surgical emergency non-vitamin k antagonist reversal |
| url | http://www.anesth-pain-med.org/upload/pdf/apm-2020-15-2-133.pdf |
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