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

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Levy, JH; Faraoni, D; Spring, JL; Douketis, JD; Samama, CM
Published in: Anesthesiology
June 2013

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.

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Published In

Anesthesiology

DOI

EISSN

1528-1175

Publication Date

June 2013

Volume

118

Issue

6

Start / End Page

1466 / 1474

Location

United States

Related Subject Headings

  • beta-Alanine
  • Warfarin
  • Thiophenes
  • Rivaroxaban
  • Pyridones
  • Pyrazoles
  • Perioperative Care
  • Morpholines
  • Intensive Care Units
  • Humans
 

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Levy, J. H., Faraoni, D., Spring, J. L., Douketis, J. D., & Samama, C. M. (2013). Managing new oral anticoagulants in the perioperative and intensive care unit setting. Anesthesiology. United States. https://doi.org/10.1097/ALN.0b013e318289bcba
Levy, Jerrold H., David Faraoni, Jenna L. Spring, James D. Douketis, and Charles M. Samama. “Managing new oral anticoagulants in the perioperative and intensive care unit setting.Anesthesiology, June 2013. https://doi.org/10.1097/ALN.0b013e318289bcba.
Levy JH, Faraoni D, Spring JL, Douketis JD, Samama CM. Managing new oral anticoagulants in the perioperative and intensive care unit setting. Vol. 118, Anesthesiology. 2013. p. 1466–74.
Levy, Jerrold H., et al. “Managing new oral anticoagulants in the perioperative and intensive care unit setting.Anesthesiology, vol. 118, no. 6, June 2013, pp. 1466–74. Pubmed, doi:10.1097/ALN.0b013e318289bcba.
Levy JH, Faraoni D, Spring JL, Douketis JD, Samama CM. Managing new oral anticoagulants in the perioperative and intensive care unit setting. Anesthesiology. 2013. p. 1466–1474.

Published In

Anesthesiology

DOI

EISSN

1528-1175

Publication Date

June 2013

Volume

118

Issue

6

Start / End Page

1466 / 1474

Location

United States

Related Subject Headings

  • beta-Alanine
  • Warfarin
  • Thiophenes
  • Rivaroxaban
  • Pyridones
  • Pyrazoles
  • Perioperative Care
  • Morpholines
  • Intensive Care Units
  • Humans