Managing new oral anticoagulants in the perioperative and intensive care unit setting.
Other Article (Journal 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
Electronic International Standard Serial Number (EISSN)
- 1528-1175
Digital Object Identifier (DOI)
- 10.1097/ALN.0b013e318289bcba
Language
- eng
Conference Location
- United States