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Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association.

Publication ,  Journal Article
Raval, AN; Cigarroa, JE; Chung, MK; Diaz-Sandoval, LJ; Diercks, D; Piccini, JP; Jung, HS; Washam, JB; Welch, BG; Zazulia, AR; Collins, SP ...
Published in: Circulation
March 7, 2017

Non-vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Knowledge of time of last ingestion of the NOAC and renal function is critical to managing these patients given that laboratory measurement is challenging because of the lack of commercially available assays in the United States. Idarucizumab is available as an antidote to rapidly reverse the effects of dabigatran. At present, there is no specific antidote available in the United States for the oral factor Xa inhibitors. Prothrombin concentrate may be considered in life-threatening bleeding. Healthcare institutions should adopt a NOAC reversal and perioperative management protocol developed with multidisciplinary input.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

March 7, 2017

Volume

135

Issue

10

Start / End Page

e604 / e633

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • United States
  • Humans
  • Hemorrhage
  • Dabigatran
  • Cardiovascular System & Hematology
  • Atrial Fibrillation
  • Antidotes
  • Anticoagulants
  • Antibodies, Monoclonal, Humanized
 

Citation

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Raval, A. N., Cigarroa, J. E., Chung, M. K., Diaz-Sandoval, L. J., Diercks, D., Piccini, J. P., … American Heart Association Clinical Pharmacology Subcommittee of the Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; and Council on Quality of Care and Outcomes Research, . (2017). Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association. Circulation, 135(10), e604–e633. https://doi.org/10.1161/CIR.0000000000000477
Raval, Amish N., Joaquin E. Cigarroa, Mina K. Chung, Larry J. Diaz-Sandoval, Deborah Diercks, Jonathan P. Piccini, Hee Soo Jung, et al. “Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association.Circulation 135, no. 10 (March 7, 2017): e604–33. https://doi.org/10.1161/CIR.0000000000000477.
Raval AN, Cigarroa JE, Chung MK, Diaz-Sandoval LJ, Diercks D, Piccini JP, et al. Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association. Circulation. 2017 Mar 7;135(10):e604–33.
Raval, Amish N., et al. “Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association.Circulation, vol. 135, no. 10, Mar. 2017, pp. e604–33. Pubmed, doi:10.1161/CIR.0000000000000477.
Raval AN, Cigarroa JE, Chung MK, Diaz-Sandoval LJ, Diercks D, Piccini JP, Jung HS, Washam JB, Welch BG, Zazulia AR, Collins SP, American Heart Association Clinical Pharmacology Subcommittee of the Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; and Council on Quality of Care and Outcomes Research. Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association. Circulation. 2017 Mar 7;135(10):e604–e633.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

March 7, 2017

Volume

135

Issue

10

Start / End Page

e604 / e633

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • United States
  • Humans
  • Hemorrhage
  • Dabigatran
  • Cardiovascular System & Hematology
  • Atrial Fibrillation
  • Antidotes
  • Anticoagulants
  • Antibodies, Monoclonal, Humanized