Insight into the perioperative management of direct oral anticoagulants: concerns and considerations
Publication in refereed journal

香港中文大學研究人員
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摘要Introduction: Direct oral anticoagulants (DOACs) have gained momentum in recent years in patients requiring anticoagulation for the prevention and management of venous thromboembolism and thromboembolic events caused by atrial fibrillation. The use of these agents involves potential bleeding complications, particularly during invasive procedures. With increasing use of DOACs, adequate knowledge regarding the perioperative management of patients on DOACs has become indispensable. Areas covered: This review covers the indications, mechanism of action, and pharmacokinetics of DOACs and their management in different perioperative settings based on various current guidelines and practices. The role of bridging therapy with heparin and the recently developed reversal agents are also discussed. Expert opinion: The perioperative management of DOACs is influenced by drug pharmacokinetics, potential comorbidities of the patient and perioperative thrombotic and bleeding risk. In low bleeding risk and minor procedures, continuing DOACs seems to be safe. Interrupting DOACs in high-risk procedures might be necessary and should be based on the elimination half-life of the drug and renal function of the patient. Further research is needed to better clarify the role of recently developed reversal agents in the perioperative setting and to identify specific laboratory tests to guide the perioperative management of DOACs.
著者Ibrahim A, Walsh LG, Algaali M, Satti Z, Kiernan TJ, Yan BP
期刊名稱Expert Opinion on Pharmacotherapy
出版年份2019
月份3
卷號20
期次4
頁次465 - 472
國際標準期刊號1465-6566
電子國際標準期刊號1744-7666
語言英式英語

上次更新時間 2020-12-09 於 03:40