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Perioperative Management of Direct Oral Anticoagulants (DOACs): A Systemic Review

Direct oral anticoagulants (DOACs) are in wide use among patients requiring both short- and long-term anticoagulation, mainly due to their ease of use and the lack of monitoring requirements. With growing use of DOACs, it is imperative that physicians be able to manage patients on these medications,...

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Autores principales: Sunkara, Tagore, Ofori, Emmanuel, Zarubin, Vadim, Caughey, Megan E., Gaduputi, Vinaya, Reddy, Madhavi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Libertas Academica 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156547/
https://www.ncbi.nlm.nih.gov/pubmed/28008269
http://dx.doi.org/10.4137/HSI.S40701
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author Sunkara, Tagore
Ofori, Emmanuel
Zarubin, Vadim
Caughey, Megan E.
Gaduputi, Vinaya
Reddy, Madhavi
author_facet Sunkara, Tagore
Ofori, Emmanuel
Zarubin, Vadim
Caughey, Megan E.
Gaduputi, Vinaya
Reddy, Madhavi
author_sort Sunkara, Tagore
collection PubMed
description Direct oral anticoagulants (DOACs) are in wide use among patients requiring both short- and long-term anticoagulation, mainly due to their ease of use and the lack of monitoring requirements. With growing use of DOACs, it is imperative that physicians be able to manage patients on these medications, especially in the perioperative period. We aim to provide guidance on the management of DOACs in the perioperative period. In this review, we performed an extensive literature search summarizing the management of patients on direct-acting anticoagulants in the perioperative period. A total of four direct-acting oral anticoagulants were considered appropriate for inclusion in this review. The drugs were dabigatran etexilate mesylate (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). Management of patients on DOACs in the perioperative period involves an assessment of thromboembolic event risk while off anticoagulation compared to the relative risk of bleeding if such drug is continued. DOACs may not need to be discontinued in minor surgeries or procedures, and in major surgeries, they may be discontinued hours prior depending on drug pharmacokinetics and renal function of the patients.
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spelling pubmed-51565472016-12-22 Perioperative Management of Direct Oral Anticoagulants (DOACs): A Systemic Review Sunkara, Tagore Ofori, Emmanuel Zarubin, Vadim Caughey, Megan E. Gaduputi, Vinaya Reddy, Madhavi Health Serv Insights Review Direct oral anticoagulants (DOACs) are in wide use among patients requiring both short- and long-term anticoagulation, mainly due to their ease of use and the lack of monitoring requirements. With growing use of DOACs, it is imperative that physicians be able to manage patients on these medications, especially in the perioperative period. We aim to provide guidance on the management of DOACs in the perioperative period. In this review, we performed an extensive literature search summarizing the management of patients on direct-acting anticoagulants in the perioperative period. A total of four direct-acting oral anticoagulants were considered appropriate for inclusion in this review. The drugs were dabigatran etexilate mesylate (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). Management of patients on DOACs in the perioperative period involves an assessment of thromboembolic event risk while off anticoagulation compared to the relative risk of bleeding if such drug is continued. DOACs may not need to be discontinued in minor surgeries or procedures, and in major surgeries, they may be discontinued hours prior depending on drug pharmacokinetics and renal function of the patients. Libertas Academica 2016-12-13 /pmc/articles/PMC5156547/ /pubmed/28008269 http://dx.doi.org/10.4137/HSI.S40701 Text en © 2016 the author(s), publisher and licensee Libertas Academica Ltd. This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.
spellingShingle Review
Sunkara, Tagore
Ofori, Emmanuel
Zarubin, Vadim
Caughey, Megan E.
Gaduputi, Vinaya
Reddy, Madhavi
Perioperative Management of Direct Oral Anticoagulants (DOACs): A Systemic Review
title Perioperative Management of Direct Oral Anticoagulants (DOACs): A Systemic Review
title_full Perioperative Management of Direct Oral Anticoagulants (DOACs): A Systemic Review
title_fullStr Perioperative Management of Direct Oral Anticoagulants (DOACs): A Systemic Review
title_full_unstemmed Perioperative Management of Direct Oral Anticoagulants (DOACs): A Systemic Review
title_short Perioperative Management of Direct Oral Anticoagulants (DOACs): A Systemic Review
title_sort perioperative management of direct oral anticoagulants (doacs): a systemic review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156547/
https://www.ncbi.nlm.nih.gov/pubmed/28008269
http://dx.doi.org/10.4137/HSI.S40701
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