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Management of Elective Surgery and Emergent Bleeding with Direct Oral Anticoagulants

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Division of Hospital Medicine, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA

    Scott Kaatz & Kulothungan Gunasekaran

  2. Department of Pharmacy, University of New Mexico, Presbyterian Healthcare Services, 1100 Central Ave. SE, Albuquerque, NM, 87106, USA

    Charles E. Mahan

  3. Department of Internal Medicine, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA

    Asaad Nakhle & Mahmoud Ali

  4. Division of General Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, USA

    Robert Lavender

  5. Department of Internal Medicine, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA

    David G. Paje

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  1. Scott Kaatz
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  2. Charles E. Mahan
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Corresponding author

Correspondence to Scott Kaatz.

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Conflict of Interest

Dr. Scott Kaatz has received research funding from Janssen; Speaker honorarium from Janssen, Boehringer-Ingelheim, Bristol Myer Squibb, Pfizer, CSL Behring, and Daiichi Sankyo; and consultant fees from Boehringer Ingelheim, Bristol Myer Squibb, Pfizer, Janssen, Daiichi Sankyo, Portola and Roche.

Dr. Charles E. Mahan has received speaker honoraria from Janssen, Bristol Myer Squibb, Pfizer, Portola, and Boehringer Ingelheim; and consultant fees from Janssen, Pfizer, Portola, and Daiichi Sankyo.

Drs Asaad Nakhle, Kulothungan Gunasekaran, Mahmoud Ali, Robert Lavender, and David G. Paje have nothing to disclose.

Human and Animal Rights and Informed Consent

This review article did not involve human or animal experimentation.

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This article is part of the topical collection on Invasive Electrophysiology and Pacing

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Kaatz, S., Mahan, C.E., Nakhle, A. et al. Management of Elective Surgery and Emergent Bleeding with Direct Oral Anticoagulants. Curr Cardiol Rep 19, 124 (2017). https://doi.org/10.1007/s11886-017-0930-2

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