Perioperative management of patients on direct oral anticoagulants

Thrombosis Journal

Review

François Mullier¹  BernardChatelain¹  Jonathan Douxfils²  Jean-Michel Dogné²  Brigitte Ickx³  Charles-Marc Samama⁴  Virginie Dubois⁵  Sarah Lessire⁶  Maximilien Gourdin⁶  Anne-Sophie Dincq⁶ 

[1] Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of LIfe Sciences (NARILIS), Namur, Belgium;Université catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Yvoir, Belgium;Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of LIfe Sciences (NARILIS), Namur, Belgium;Université de Namur, Department of Pharmacy, Faculty of Medecine, Namur, Belgium;Université Libre de Bruxelles, Erasme University Hospital,Department of Anesthesiology, Brussels, Belgium;Université Paris Descartes, Cochin University Hospital,Department of Anesthesiology and Intensive Care, Paris, France;Université catholique de Louvain, CHU UCL Namur, Department of Anesthesiology, Yvoir, Belgium;Université catholique de Louvain, CHU UCL Namur, Department of Anesthesiology, Yvoir, Belgium;Namur Thrombosis and Hemostasis Center (NTHC), NAmur Research Institute of LIfe Sciences (NARILIS), Namur, Belgium;

关键词: Anticoagulants;    Perioperative period;    Invasive procedures;    Spinal anesthesia;    Emergency care;    Blood coagulation test;   

DOI  :  10.1186/s12959-017-0137-1

 received in 2016-11-27, accepted in 2017-05-04,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017