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Perioperative Management of Patients Taking Direct Oral Anticoagulants: A Review.
JAMA
September 2024
Department of Medicine, Anticoagulation and Clinical Thrombosis Service, Northwell Health at Lenox Hill Hospital, New York, New York.
Importance: Direct oral anticoagulants (DOACs), comprising apixaban, rivaroxaban, edoxaban, and dabigatran, are commonly used medications to treat patients with atrial fibrillation and venous thromboembolism. Decisions about how to manage DOACs in patients undergoing a surgical or nonsurgical procedure are important to decrease the risks of bleeding and thromboembolism.
Observations: For elective surgical or nonsurgical procedures, a standardized approach to perioperative DOAC management involves classifying the risk of procedure-related bleeding as minimal (eg, minor dental or skin procedures), low to moderate (eg, cholecystectomy, inguinal hernia repair), or high risk (eg, major cancer or joint replacement procedures).
[Overdosing of direct oral anticoagulants].
Med Klin Intensivmed Notfmed
June 2024
Klinik I für Innere Medizin, Centrum für integrierte Onkologie Aachen Bonn Köln Düsseldorf, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
Background: Direct oral anticoagulants (DOAC) are increasingly used for prophylaxis and treatment of thromboembolic events. Incorrectly dosed DOAC treatment is associated with excess mortality.
Purpose: This article aims at raising awareness of DOAC overdosing and its causes as well as presenting a diagnostic and therapeutic work-up.
Idarucizumab in dabigatran-treated patients with acute stroke: a review and clinical update.
Front Neurol
May 2024
Department of Neurology, Nordwest-Krankenhaus Sanderbusch, Friesland Kliniken GmbH, Sande, Germany.
Idarucizumab is an antibody fragment specific for the immediate reversal of dabigatran anticoagulation effects. The use of idarucizumab is approved for dabigatran-treated patients suffering from life-threatening or uncontrolled bleeding and those in need of urgent surgery or invasive procedures. Data from randomized controlled clinical trials and real-world experience provide reassuring evidence about the efficacy and safety of idarucizmab use in patients with acute stroke.
View Article and Find Full Text PDFIs there a role for the laboratory monitoring in the management of specific antidotes of direct oral anticoagulants?
Thromb Res
May 2024
Paris Cité University, INSERM, Innovative Therapies in Haemostasis, F-75006 Paris, France; Laboratory of Hematology, Lariboisière hospital, AP-HP. Nord, F-75010 Paris, France. Electronic address:
Article Synopsis
- More people are taking a type of medicine called DOAC, and sometimes they need immediate help if they bleed a lot or need surgery.
- There are special medicines called antidotes like idarucizumab for dabigatran and andexanet alfa for other DOACs to stop the effects quickly.
- It's important to measure how much DOAC is in a person's blood to know if they need these antidotes, but sometimes the tests can be confusing after using the antidotes, so more research is needed on how to manage this well.
Treatment of dabigatran intoxication in critically ill patients with Acute Kidney Injury: The role of Sustained Low-Efficiency Dialysis.
Int J Artif Organs
November 2023
UO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Parma, Italy.
The use of dabigatran in patients with non-valvular atrial fibrillation (AF) has widely increased in the last decades, due to its positive effects in terms of safety/efficacy. However, because of the risk of major bleeding, a great degree of attention has been suggested in elderly patients with multiple comorbidities. Notably, dabigatran mainly undergoes renal elimination and dose adjustment is recommended in patients with Chronic Kidney Disease (CKD).
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