Managing new oral anticoagulants in the perioperative and intensive care unit setting.

Published

Other Article (Review)

Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with any anticoagulant (including the known principles for warfarin) should be considered. This review summarizes the available data regarding the management of bleeding with novel oral anticoagulation agents. Hemodialysis is a therapeutic option for dabigatran-related bleeding, while in vitro studies showed that prothrombin complex concentrates are reported to be useful for rivaroxaban-related bleeding. Additional clinical studies are needed to determine the best method for reversal of the novel oral anticoagulation agents when bleeding occurs.

Full Text

Duke Authors

Cited Authors

  • Levy, JH; Faraoni, D; Spring, JL; Douketis, JD; Samama, CM

Published Date

  • June 2013

Published In

Volume / Issue

  • 118 / 6

Start / End Page

  • 1466 - 1474

PubMed ID

  • 23416382

Pubmed Central ID

  • 23416382

Electronic International Standard Serial Number (EISSN)

  • 1528-1175

Digital Object Identifier (DOI)

  • 10.1097/ALN.0b013e318289bcba

Language

  • eng

Conference Location

  • United States