Management of novel oral anticoagulants like dabigatran and rivaroxaban during transitions, surgery, or hemorrhage requires specific strategies based on their pharmacokinetics and mechanism of action.
How should clinicians manage the transition between novel oral anticoagulants (dabigatran, rivaroxaban) and warfarin, particularly around surgery or in cases of major hemorrhage?
This review provides practical guidance for clinicians on how to manage the transition between warfarin and novel oral anticoagulants (dabigatran, rivaroxaban), including perioperative and bleeding management.
Two novel oral anticoagulants, dabigatran and rivaroxaban, have recently been approved. They differ in many ways from warfarin, including rapid onset of action, shorter half-life, fewer drug-drug interactions, lack of need for monitoring, and no need for titration or dose adjustments. These novel agents represent a landmark shift in anticoagulant care; however, many aspects of their use will be unfamiliar to practicing clinicians, despite the imminent widespread use of these agents in the community. The management of these anticoagulants when transitioning from or back to warfarin, around surgery or in case of major hemorrhage, requires knowledge of their pharmacokinetics and mechanism of action. Unfortunately, there is a limited evidence base to inform decisions around management of these agents. We present our practice in these settings supported, where available, with literature evidence.
Schulman et al. (Thu,) conducted a review in Anticoagulation therapy management. Novel oral anticoagulants (dabigatran, rivaroxaban) vs. Warfarin was evaluated. Management of novel oral anticoagulants like dabigatran and rivaroxaban during transitions, surgery, or hemorrhage requires specific strategies based on their pharmacokinetics and mechanism of action.
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