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Internal and Emergency Medicine

, Volume 13, Issue 7, pp 997–999 | Cite as

A clinical conundrum: to measure or not measure direct oral anticoagulants before a surgery or procedure?

  • James D. Douketis
  • Mansoor Radwi
IM - COMMENTARY

The management of patients who are receiving a direct oral anticoagulant (DOAC) and require a surgery or an invasive procedure is a common clinical problem, with 500,000–750,000 such patients being assessed annually in North America and Europe alone, and is pertinent to a wide array of clinicians that includes internists, surgeons and anaesthetists [1, 2]. The future scope of this problem is likely to increase as more patients receive a DOAC instead of a vitamin K antagonist (VKA) for the management of atrial fibrillation and venous thromboembolism especially in an ageing population, as elderly patients are most likely to require a surgery or invasive procedure [3].

The overall perioperative management of patients who are receiving an anticoagulant has shifted away from bridging with a low-molecular-weight heparin during anticoagulant interruption, given recent evidence that heparin bridging results in more bleeds without a reduction in thromboembolism whether patients are receiving...

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

None.

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Copyright information

© Società Italiana di Medicina Interna 2018

Authors and Affiliations

  1. 1.Department of MedicineSt. Joseph’s Healthcare Hamilton and McMaster UniversityHamiltonCanada
  2. 2.Department of Hematology, Faculty of MedicineUniversity of JeddahJeddahSaudi Arabia

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