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Management of oral anticoagulants prior to emergency surgery or with major bleeding: A survey of perioperative practices in North America: Communication from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis

BACKGROUND: There is limited information on real‐world practice versus current clinical practice guidelines for oral anticoagulant reversal before emergency surgery. OBJECTIVE: To identify current practice/knowledge gaps for oral anticoagulant reversal emergency surgery among anesthesiologists. METH...

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Autores principales: Levy, Jerrold H., Connors, Jean M., Steiner, Marie E., Douketis, James, Spyropoulos, Alex C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292675/
https://www.ncbi.nlm.nih.gov/pubmed/32548554
http://dx.doi.org/10.1002/rth2.12320
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author Levy, Jerrold H.
Connors, Jean M.
Steiner, Marie E.
Douketis, James
Spyropoulos, Alex C.
author_facet Levy, Jerrold H.
Connors, Jean M.
Steiner, Marie E.
Douketis, James
Spyropoulos, Alex C.
author_sort Levy, Jerrold H.
collection PubMed
description BACKGROUND: There is limited information on real‐world practice versus current clinical practice guidelines for oral anticoagulant reversal before emergency surgery. OBJECTIVE: To identify current practice/knowledge gaps for oral anticoagulant reversal emergency surgery among anesthesiologists. METHODS: A 22‐question survey covering aspects of clinical practice relating to oral anticoagulant reversal was sent to American Society of Anesthesiology members with weekly reminders during data collection from October to December 2018. RESULTS: Responses were received from 2315 anesthesiologists of which 86% of respondents were United States based. Emergency surgery was defined as occurring within 4 hours of the decision to operate by 60% of respondents. Fresh frozen plasma (FFP) was used by 75% of respondents for vitamin K antagonist (VKA) reversal and by 54% for direct oral anticoagulant (DOAC) reversal in emergency surgery and 67% in major operative bleeding. Only 32% of institutions had emergency anticoagulant reversal protocols, and 54% of respondents selected an international normalized ration (INR) ratio goal for VKA reversal of ≤1.5. Only 13% initially consulted or coordinated management with hematologists, and the final decision regarding coagulation management was made by the respondent in 26% of cases. A coordinated approach with hematologists and cardiologists was reported by 64%, and over half (51%) required approval for prothrombin complex concentrate administration for emergency procedures. CONCLUSIONS: Despite recommendations to the contrary, FFP is extensively used for emergency VKA and DOAC reversal. There is a clear need for institutions to develop guideline‐informed recommendations/management algorithms based on input from medical professionals routinely involved in management of these patients.
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spelling pubmed-72926752020-06-15 Management of oral anticoagulants prior to emergency surgery or with major bleeding: A survey of perioperative practices in North America: Communication from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis Levy, Jerrold H. Connors, Jean M. Steiner, Marie E. Douketis, James Spyropoulos, Alex C. Res Pract Thromb Haemost Original Article: Thrombosis BACKGROUND: There is limited information on real‐world practice versus current clinical practice guidelines for oral anticoagulant reversal before emergency surgery. OBJECTIVE: To identify current practice/knowledge gaps for oral anticoagulant reversal emergency surgery among anesthesiologists. METHODS: A 22‐question survey covering aspects of clinical practice relating to oral anticoagulant reversal was sent to American Society of Anesthesiology members with weekly reminders during data collection from October to December 2018. RESULTS: Responses were received from 2315 anesthesiologists of which 86% of respondents were United States based. Emergency surgery was defined as occurring within 4 hours of the decision to operate by 60% of respondents. Fresh frozen plasma (FFP) was used by 75% of respondents for vitamin K antagonist (VKA) reversal and by 54% for direct oral anticoagulant (DOAC) reversal in emergency surgery and 67% in major operative bleeding. Only 32% of institutions had emergency anticoagulant reversal protocols, and 54% of respondents selected an international normalized ration (INR) ratio goal for VKA reversal of ≤1.5. Only 13% initially consulted or coordinated management with hematologists, and the final decision regarding coagulation management was made by the respondent in 26% of cases. A coordinated approach with hematologists and cardiologists was reported by 64%, and over half (51%) required approval for prothrombin complex concentrate administration for emergency procedures. CONCLUSIONS: Despite recommendations to the contrary, FFP is extensively used for emergency VKA and DOAC reversal. There is a clear need for institutions to develop guideline‐informed recommendations/management algorithms based on input from medical professionals routinely involved in management of these patients. John Wiley and Sons Inc. 2020-03-02 /pmc/articles/PMC7292675/ /pubmed/32548554 http://dx.doi.org/10.1002/rth2.12320 Text en © 2020 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals, Inc on behalf of International Society on Thrombosis and Haemostasis. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/3.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Article: Thrombosis
Levy, Jerrold H.
Connors, Jean M.
Steiner, Marie E.
Douketis, James
Spyropoulos, Alex C.
Management of oral anticoagulants prior to emergency surgery or with major bleeding: A survey of perioperative practices in North America: Communication from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis
title Management of oral anticoagulants prior to emergency surgery or with major bleeding: A survey of perioperative practices in North America: Communication from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis
title_full Management of oral anticoagulants prior to emergency surgery or with major bleeding: A survey of perioperative practices in North America: Communication from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis
title_fullStr Management of oral anticoagulants prior to emergency surgery or with major bleeding: A survey of perioperative practices in North America: Communication from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis
title_full_unstemmed Management of oral anticoagulants prior to emergency surgery or with major bleeding: A survey of perioperative practices in North America: Communication from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis
title_short Management of oral anticoagulants prior to emergency surgery or with major bleeding: A survey of perioperative practices in North America: Communication from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis
title_sort management of oral anticoagulants prior to emergency surgery or with major bleeding: a survey of perioperative practices in north america: communication from the scientific and standardization committees on perioperative and critical care haemostasis and thrombosis of the international society on thrombosis and haemostasis
topic Original Article: Thrombosis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292675/
https://www.ncbi.nlm.nih.gov/pubmed/32548554
http://dx.doi.org/10.1002/rth2.12320
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