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Direct Oral Anticoagulants: An Update on Monitoring and Antidotes for the Perioperative Physician

  • Blood Management (KA Tanaka, Section Editor)
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Abstract

Purpose of Review

The purpose of this review is to update the clinician on assessing and reversing the effects of direct oral anticoagulants (DOACs) in the perioperative period.

Recent Findings

Traditional coagulation tests such as the PT and aPTT are not recommended to determine clinically significant effects of DOACs. Instead, the dilute thrombin time and chromogenic anti-Xa level can be used to guide the need for reversal of direct thrombin inhibitors and Factor Xa inhibitors respectively. Additionally, point of care assays such as viscoelastic testing and urine screening are under investigation. Current reversal strategies include the use of idarucizumab, andexanet alfa, and prothrombin complex concentrates prior to emergent surgery that cannot be delayed for DOAC effects to dissipate.

Summary

Given their relatively short half-lives, regular monitoring of DOACs is not needed, but perioperative physicians should be aware of available tests for determining the need to emergently reverse their effects.

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Authors and Affiliations

  1. Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA

    Antasia Giebler

  2. Department of Anesthesiology, Emory University School of Medicine, Emory University Hospital Tower – 5th floor, 1750 Gambrell Drive N.E., Atlanta, GA, 30322, USA

    Roman Sniecinski

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  1. Antasia Giebler
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AG performed the literature search and contributed to writing and editing the manuscript. RS contributed to the main text and designed the figure and table.

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Correspondence to Roman Sniecinski.

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AG has no financial or competing interests. RS has received research funding from Cerus corporation and stock options from Anesthesia Labs, Inc for advisory panel work. He is also the co-founder and Vice President of Tractio Diagnostics, Inc.

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Giebler, A., Sniecinski, R. Direct Oral Anticoagulants: An Update on Monitoring and Antidotes for the Perioperative Physician. Curr Anesthesiol Rep (2024). https://doi.org/10.1007/s40140-024-00631-2

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