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Exploring the Perioperative Use of DOACs, off the Beaten Track. | LitMetric

AI Article Synopsis

  • There has been a significant rise in the use of direct oral anticoagulants (DOACs) over the past ten years, surpassing vitamin K antagonists (VKAs) due to easier management and better safety profiles.
  • Managing anticoagulation for patients on DOACs during surgical or interventional procedures is complex, as some surgeries require stopping DOACs while others can proceed uninterrupted.
  • A thorough assessment of patient factors (like age, bleeding history, and organ function) and surgical details is crucial for determining the best timing for stopping and resuming DOACs, necessitating a collaborative approach among healthcare providers.

Article Abstract

A notable increase in direct oral anticoagulant (DOAC) use has been observed in the last decade. This trend has surpassed the prescription of vitamin K antagonists (VKAs) due to the absence of the need for regular laboratory monitoring and the more favorable characteristics in terms of efficacy and safety. However, it is very common that patients on DOACs need an interventional or surgical procedure, requiring a careful evaluation and a challenging approach. Therefore, perioperative anticoagulation management of patients on DOACs represents a growing concern for clinicians. Indeed, while several surgical interventions require temporary discontinuation of DOACs, other procedures that involve a lower risk of bleeding can be conducted, maintaining a minimal or uninterrupted DOAC strategy. Therefore, a comprehensive evaluation of patient characteristics, including age, susceptibility to stroke, previous bleeding complications, concurrent medications, renal and hepatic function, and other factors, in addition to surgical considerations, is mandatory to establish the optimal discontinuation and resumption timing of DOACs. A multidisciplinary approach is required for managing perioperative anticoagulation in order to establish how to face these circumstances. This narrative review aims to provide physicians with a practical guide for DOAC perioperative management, addressing the most controversial issues.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11172442PMC
http://dx.doi.org/10.3390/jcm13113076DOI Listing

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