What question did this study set out to answer?

To review available evidence and clinical considerations for discontinuing novel oral anticoagulants prior to elective surgery and managing acute bleeding complications.

February 15, 2013Anesthesiology

Managing New Oral Anticoagulants in the Perioperative and Intensive Care Unit Setting

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Why the study?

How should bleeding be managed in patients receiving novel oral anticoagulants in the perioperative setting?

Population

Patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or…

Design

Review

Authors

JLJerrold H. LevyCardiac Surgery DFDavid FaraoniPediatric / Congenital Cardiology JSJenna SpringSinai Health System

Discussion

Member takes

Implication

May guide perioperative NOAC bleeding management with hemodialysis for dabigatran and PCC for rivaroxaban; leaves open confirmation in prospective trials.

Key Points

To review available evidence and clinical considerations for discontinuing novel oral anticoagulants prior to elective surgery and managing acute bleeding complications.
Narrative review synthesizing pharmacology, renal clearance mechanisms, and bleeding management protocols for direct Factor Xa inhibitors (rivaroxaban, apixaban) and direct thrombin inhibitors (dabigatran).
Preoperative discontinuation timelines must account for renal function because novel oral anticoagulants heavily rely on renal clearance for elimination.
Hemodialysis provides a therapeutic clearance strategy for dabigatran-related bleeding, whereas in vitro evidence indicates prothrombin complex concentrates help reverse rivaroxaban-associated bleeding.

Structured PICO

How should bleeding be managed in patients receiving novel oral anticoagulants in the perioperative setting?

Population

Patients in the perioperative setting receiving novel oral anticoagulation agents (rivaroxaban, apixaban, dabigatran) for thromboprophylaxis or stroke prevention with atrial fibrillation

Intervention

Bleeding management and reversal strategies (e.g., hemodialysis for dabigatran, prothrombin complex concentrates for rivaroxaban)

Outcome

Management of bleeding

This review highlights that while hemodialysis may help reverse dabigatran and prothrombin complex concentrates may reverse rivaroxaban, further clinical studies are needed to establish optimal bleeding management for novel oral anticoagulants.

Limitations

Additional clinical studies are needed to determine the best method for reversal of the novel oral anticoagulation agents when bleeding occurs.

Cite This Study

Levy et al. (2013) studied this question.

synapsesocial.com/papers/6a76e58cde5e3adfbdf6d998 https://doi.org/10.1097/aln.0b013e318289bcba

Topics

Anticoagulation in AF

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Implication

May guide perioperative NOAC bleeding management with hemodialysis for dabigatran and PCC for rivaroxaban; leaves open confirmation in prospective trials.

Managing New Oral Anticoagulants in the Perioperative and Intensive Care Unit Setting

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Managing New Oral Anticoagulants in the Perioperative and Intensive Care Unit Setting

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider