What is the clinical evidence from this study?

Study design: Review. Population: Patients taking direct oral anticoagulants (DOACs) requiring emergency invasive procedures. Intervention: Management strategies and reversal agents (e.g., idarucizumab, andexanet alfa, ciraparantag).

What question did this study set out to answer?

To review evaluation protocols, procedural interruption guidelines, and targeted reversal strategies for patients receiving direct oral anticoagulants who require emergency invasive interventions.

August 31, 2016The American Journal of MedicineOpen Access

Discontinuation and Management of Direct-Acting Anticoagulants for Emergency Procedures

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Key result

Specialized management strategies, including specific stopping rules and the use of novel reversal agents like idarucizumab, are required for patients on DOACs needing emergency invasive procedures.

Why the study?

How should patients taking direct oral anticoagulants be managed when requiring emergency invasive procedures?

Population

Patients taking direct oral anticoagulants (DOACs) who require emergency invasive procedures or surgery

Design

Review

Authors

JLJerrold H. LevyCardiac Surgery

Discussion

Member takes

Implication

May inform DOAC management in emergencies; hypothesis-generating and requires prospective validation before practice change.

Key Points

To review evaluation protocols, procedural interruption guidelines, and targeted reversal strategies for patients receiving direct oral anticoagulants who require emergency invasive interventions.
Review of clinical management frameworks for direct oral anticoagulant interruption, procedural bleeding risk assessment, and coagulation monitoring assays.
Evaluation of pharmacologic properties and clinical indications for targeted reversal agents, including idarucizumab, andexanet alfa, and ciraparantag.
Elective interruption schedules generally mandate stopping direct oral anticoagulants for at least 24 hours prior to low-risk interventions and at least 48 hours before high-risk operations in individuals with normal renal clearance, whereas routine heparin bridging is increasingly questioned.
Idarucizumab provides rapid, complete, and sustained reversal of dabigatran-induced anticoagulation during life-threatening bleeding and emergency surgical procedures.
Targeted decoy proteins, such as andexanet alfa for factor Xa inhibitors, and synthetic broad-spectrum binders, such as ciraparantag, provide mechanisms to reestablish hemostasis during urgent surgical scenarios.

Structured PICO

How should patients taking direct oral anticoagulants be managed when requiring emergency invasive procedures?

Population

Patients taking direct oral anticoagulants (DOACs) who require emergency invasive procedures or surgery

Intervention

DOAC reversal agents (idarucizumab, andexanet alfa, ciraparantag) and periprocedural management strategies (stopping rules, bridging therapy)

Specific reversal agents such as idarucizumab and emerging agents like andexanet alfa and ciraparantag offer targeted strategies for managing DOAC-treated patients during emergency procedures.

Cite This Study

Jerrold H. Levy (2016) conducted a review in Patients taking direct oral anticoagulants (DOACs) requiring emergency invasive procedures. Management strategies and reversal agents (e.g., idarucizumab, andexanet alfa, ciraparantag) was evaluated. Specialized management strategies, including specific stopping rules and the use of novel reversal agents like idarucizumab, are required for patients on DOACs needing emergency invasive procedures.

synapsesocial.com/papers/6a7a2cf4e357fbdac5896571 https://doi.org/10.1016/j.amjmed.2016.06.005

Topics

Anticoagulation in AF

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Discontinuation and Management of Direct-Acting Anticoagulants for Emergency Procedures

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Discontinuation and Management of Direct-Acting Anticoagulants for Emergency Procedures

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider