Scott Kaatz1, Charles E Mahan2, Asaad Nakhle3, Kulothungan Gunasekaran4, Mahmoud Ali3, Robert Lavender5, David G Paje6. 1. Division of Hospital Medicine, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA. Skaatz1@hfhs.org. 2. Department of Pharmacy, University of New Mexico, Presbyterian Healthcare Services, 1100 Central Ave. SE, Albuquerque, NM, 87106, USA. 3. Department of Internal Medicine, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA. 4. Division of Hospital Medicine, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA. 5. Division of General Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, USA. 6. Department of Internal Medicine, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA.
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. 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.
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. 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.
Entities:
Keywords:
Andexanet alfa; Bleeding; Direct oral anticoagulants (DOAC); Idarucizumab; Reversal; Surgery
Authors: Hervé Decousus; Victor F Tapson; Jean-François Bergmann; Beng H Chong; James B Froehlich; Ajay K Kakkar; Geno J Merli; Manuel Monreal; Mashio Nakamura; Ricardo Pavanello; Mario Pini; Franco Piovella; Frederick A Spencer; Alex C Spyropoulos; Alexander G G Turpie; Rainer B Zotz; Gordon Fitzgerald; Frederick A Anderson Journal: Chest Date: 2010-05-07 Impact factor: 9.410
Authors: Shashi Kumar; Stephan B Danik; Robert K Altman; Conor D Barrett; Gregory Y H Lip; Saurav Chatterjee; Gary S Roubin; Andrea Natale; Jacqueline S Danik Journal: Cardiol Rev Date: 2016 Sep-Oct Impact factor: 2.644
Authors: Nadine Shehab; Maribeth C Lovegrove; Andrew I Geller; Kathleen O Rose; Nina J Weidle; Daniel S Budnitz Journal: JAMA Date: 2016-11-22 Impact factor: 56.272
Authors: Francesco Dentali; Chiara Marchesi; Matteo Giorgi Pierfranceschi; Mark Crowther; David Garcia; Elaine Hylek; Daniel M Witt; Nathan P Clark; Alessandro Squizzato; Davide Imberti; Walter Ageno Journal: Thromb Haemost Date: 2011-07-28 Impact factor: 5.249
Authors: James D Douketis; Jeff S Healey; Martina Brueckmann; John W Eikelboom; Michael D Ezekowitz; Mandy Fraessdorf; Herbert Noack; Jonas Oldgren; Paul Reilly; Alex C Spyropoulos; Lars Wallentin; Stuart J Connolly Journal: Thromb Haemost Date: 2014-12-04 Impact factor: 5.249
Authors: Charles E Mahan; Alex C Spyropoulos; Maxine D Fisher; Larry E Fields; Roger M Mills; Judith J Stephenson; An-Chen Fu; Winslow Klaskala Journal: Clin Appl Thromb Hemost Date: 2013-01-15 Impact factor: 2.389
Authors: Stuart J Connolly; Truman J Milling; John W Eikelboom; C Michael Gibson; John T Curnutte; Alex Gold; Michele D Bronson; Genmin Lu; Pamela B Conley; Peter Verhamme; Jeannot Schmidt; Saskia Middeldorp; Alexander T Cohen; Jan Beyer-Westendorf; Pierre Albaladejo; Jose Lopez-Sendon; Shelly Goodman; Janet Leeds; Brian L Wiens; Deborah M Siegal; Elena Zotova; Brandi Meeks; Juliet Nakamya; W Ting Lim; Mark Crowther Journal: N Engl J Med Date: 2016-08-30 Impact factor: 91.245
Authors: Ann Beckmann; Julia Spalteholz; Florian Langer; Hans Heinzer; Lars Budäus; Derya Tilki; Uwe Michl; Armin Soave; Thomas Steuber; Valia Veleva; Georg Salomon; Alexander Haese; Hartwig Huland; Markus Graefen; Hendrik Isbarn Journal: World J Urol Date: 2019-02-06 Impact factor: 4.226
Authors: T Piegeler; S N Stehr; D Pfirrmann; M Knödler; F Lordick; A Mehnert; L Selig; A Weimann; M Mehdorn; I Gockel; P Simon Journal: Chirurg Date: 2018-11 Impact factor: 0.955