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Direct oral anticoagulants and their antagonists in perioperative practice.

Publication ,  Journal Article
Levy, JH; Mamoun, N
Published in: Curr Opin Anaesthesiol
August 1, 2023

PURPOSE OF REVIEW: Review management strategies for patients receiving nonvitamin K direct-acting oral anticoagulants (DOACs). RECENT FINDINGS: Updated clinical trials and guidelines continue to further define optimal management for patients on DOACs requiring emergency surgery or procedural interventions. In addition, specific bleeding management strategies that include either specific or nonspecific antagonists are becoming available. SUMMARY: Most currently used DOACs are factor Xa inhibitors and should be stopped for 24-48 h for elective surgical procedures in patients at risk for bleeding and potentially longer for dabigatran, depending on renal function. Idarucizumab, a specific dabigatran reversal agent, has been studied in surgical patients and is currently approved for use. For Xa inhibitors apixaban and rivaroxaban, although andexanet alfa is approved for medical bleeds, it is not approved for surgical patients, has a short duration of effect, and costs $12 500 per gram. When managing DOAC-treated patients requiring emergency surgery, when stopping the DOAC and delaying surgery is not feasible, standard approaches should include hemostatic, hemodynamic, and transfusional support. Due to higher risk associated with therapeutic agents used to manage DOAC-related bleeding, increasing data supports the potential off-label use of prothrombin complex concentrate (PCC).

Duke Scholars

Published In

Curr Opin Anaesthesiol

DOI

EISSN

1473-6500

Publication Date

August 1, 2023

Volume

36

Issue

4

Start / End Page

394 / 398

Location

United States

Related Subject Headings

  • Rivaroxaban
  • Humans
  • Hemorrhage
  • Factor Xa Inhibitors
  • Dabigatran
  • Anticoagulants
  • Anesthesiology
  • Administration, Oral
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
 

Citation

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Levy, J. H., & Mamoun, N. (2023). Direct oral anticoagulants and their antagonists in perioperative practice. Curr Opin Anaesthesiol, 36(4), 394–398. https://doi.org/10.1097/ACO.0000000000001275
Levy, Jerrold H., and Negmeldeen Mamoun. “Direct oral anticoagulants and their antagonists in perioperative practice.Curr Opin Anaesthesiol 36, no. 4 (August 1, 2023): 394–98. https://doi.org/10.1097/ACO.0000000000001275.
Levy JH, Mamoun N. Direct oral anticoagulants and their antagonists in perioperative practice. Curr Opin Anaesthesiol. 2023 Aug 1;36(4):394–8.
Levy, Jerrold H., and Negmeldeen Mamoun. “Direct oral anticoagulants and their antagonists in perioperative practice.Curr Opin Anaesthesiol, vol. 36, no. 4, Aug. 2023, pp. 394–98. Pubmed, doi:10.1097/ACO.0000000000001275.
Levy JH, Mamoun N. Direct oral anticoagulants and their antagonists in perioperative practice. Curr Opin Anaesthesiol. 2023 Aug 1;36(4):394–398.

Published In

Curr Opin Anaesthesiol

DOI

EISSN

1473-6500

Publication Date

August 1, 2023

Volume

36

Issue

4

Start / End Page

394 / 398

Location

United States

Related Subject Headings

  • Rivaroxaban
  • Humans
  • Hemorrhage
  • Factor Xa Inhibitors
  • Dabigatran
  • Anticoagulants
  • Anesthesiology
  • Administration, Oral
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology