Key result
The timing of cessation of target-specific oral anticoagulants before surgery depends on procedural bleeding risk and patient renal function, and perioperative bridging is generally unnecessary.
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An in-depth understanding of the pharmacokinetics and renal clearance of target-specific oral anticoagulants is essential to guide their perioperative cessation and resumption to minimize bleeding and thrombosis risks.
The target-specific oral anticoagulants (TSOACs), eg, dabigatran, rivaroxaban, and apixaban, are changing the way we manage thromboembolic disease. At the same time, many clinicians wonder how best to manage TSOAC therapy when patients need surgery. An in-depth understanding of these drugs is essential to minimize the risk of bleeding and thrombosis perioperatively.
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Anderson et al. (2014) conducted a review in Patients on target-specific oral anticoagulants needing surgery. Target-specific oral anticoagulants (dabigatran, rivaroxaban, apixaban) was evaluated. The timing of cessation of target-specific oral anticoagulants before surgery depends on procedural bleeding risk and patient renal function, and perioperative bridging is generally unnecessary.
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