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Current Cardiology Reports
Published in: Current Cardiology Reports 12/2017

01-12-2017 | Invasive Electrophysiology and Pacing (EK Heist, Section Editor)

Management of Elective Surgery and Emergent Bleeding with Direct Oral Anticoagulants

Authors: Scott Kaatz, Charles E. Mahan, Asaad Nakhle, Kulothungan Gunasekaran, Mahmoud Ali, Robert Lavender, David G. Paje

Published in: Current Cardiology Reports | Issue 12/2017

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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.

Summary

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.
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Metadata
Title
Management of Elective Surgery and Emergent Bleeding with Direct Oral Anticoagulants
Authors
Scott Kaatz
Charles E. Mahan
Asaad Nakhle
Kulothungan Gunasekaran
Mahmoud Ali
Robert Lavender
David G. Paje
Publication date
01-12-2017
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 12/2017
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-017-0930-2

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