Current Cardiology Reports

, 19:124 | Cite as

Management of Elective Surgery and Emergent Bleeding with Direct Oral Anticoagulants

  • Scott Kaatz
  • Charles E. Mahan
  • Asaad Nakhle
  • Kulothungan Gunasekaran
  • Mahmoud Ali
  • Robert Lavender
  • David G. Paje
Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Invasive Electrophysiology and Pacing

Abstract

Purpose of Review

The purpose of this review was to offer practical management strategies for when patients receiving direct oral anticoagulants require elective surgery or present with bleeding complications.

Recent Findings

Clinical practice guidelines are now available on the timing of periprocedural interruption of treatment with the newer direct oral anticoagulants based on their pharmacodynamics and pharmacokinetics and based on findings from cohort studies and clinical trials. An antibody that reverses the effects of dabigatran is now available, and a factor Xa decoy is being developed as an antidote to apixaban, betrixaban, edoxaban, and rivaroxaban.

Summary

The timing of interruption of direct oral anticoagulants for elective surgery is based on multiple factors, including pharmacologic properties and interactions, the patient’s renal function, and the type of planned surgery. There is little role for low-molecular-weight heparin bridging. Idarucizumab is the treatment of choice for dabigatran-related life-threatening bleeding, while andexanet alfa is being developed to reverse factor Xa inhibitors.

Keywords

Direct oral anticoagulants (DOAC) Reversal Bleeding Surgery Idarucizumab Andexanet alfa 

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Scott Kaatz
    • 1
  • Charles E. Mahan
    • 2
  • Asaad Nakhle
    • 3
  • Kulothungan Gunasekaran
    • 1
  • Mahmoud Ali
    • 3
  • Robert Lavender
    • 4
  • David G. Paje
    • 5
  1. 1.Division of Hospital MedicineHenry Ford HospitalDetroitUSA
  2. 2.Department of PharmacyUniversity of New Mexico, Presbyterian Healthcare ServicesAlbuquerqueUSA
  3. 3.Department of Internal MedicineHenry Ford HospitalDetroitUSA
  4. 4.Division of General Internal MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA
  5. 5.Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborUSA

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