Advertisement
Review Article| Volume 40, ISSUE 1, P93-109, December 2022

Contemporary Perioperative Management of Direct Oral Anticoagulants

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Advances in Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cuker A.
        • Burnett A.
        • Triller D.
        • et al.
        Reversal of direct oral anticoagulants: guidance from the anticoagulation forum.
        Am J Hematol. 2019; 94: 697-709
        • Lauffenburger J.C.
        • Farley J.F.
        • Gehi A.K.
        • et al.
        Factors driving anticoagulant selection in patients with atrial fibrillation in the United States.
        Am J Cardiol. 2015; 115: 1095-1101
        • Wardrop D.
        • Keeling D.
        The story of the discovery of heparin and warfarin.
        Br J Haematol. 2008; 141: 757-763
        • Becker R.C.
        Factor Xa inhibitors: critical considerations for clinical development and testing.
        J Thromb Thrombolysis. 2021; 52: 397-402
        • Schreuder M.
        • Reitsma P.H.
        • Bos M.H.A.
        Reversal agents for the direct factor xa inhibitors: biochemical mechanisms of current and newly emerging therapies.
        Semin Thromb Hemost. 2020; 46: 986-998
        • Yeh C.H.
        • Fredenburgh J.C.
        • Weitz J.I.
        Oral direct factor Xa inhibitors.
        Circ Res. 2012; 111: 1069-1078
        • Baker W.L.
        • Cios D.A.
        • Sander S.D.
        • et al.
        Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States.
        J Manag Care Pharm. 2009; 15: 244-252
        • Verma A.
        • Ha A.C.T.
        • Rutka J.T.
        • et al.
        What surgeons should know about non-vitamin K oral anticoagulants: a review.
        JAMA Surg. 2018; 153: 577-585
        • January C.T.
        • Wann L.S.
        • Calkins H.
        • et al.
        2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
        Heart Rhythm. 2019; 16: e66-e93
        • Hindricks G.
        • Potpara T.
        • Dagres N.
        • et al.
        2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC.
        Eur Heart J. 2021; 42: 373-498
        • Stevens S.M.
        • Woller S.C.
        • Kreuziger L.B.
        • et al.
        Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report.
        Chest. 2021; 160: e545-e608
        • Laux V.
        • Perzborn E.
        • Heitmeier S.
        • et al.
        Direct inhibitors of coagulation proteins - the end of the heparin and low-molecular-weight heparin era for anticoagulant therapy?.
        Thromb Haemost. 2009; 102: 892-899
        • Chai-Adisaksopha C.
        • Crowther M.
        • Isayama T.
        • et al.
        The impact of bleeding complications in patients receiving target-specific oral anticoagulants: a systematic review and meta-analysis.
        Blood. 2014; 124: 2450-2458
        • Samuelson B.T.
        • Cuker A.
        Measurement and reversal of the direct oral anticoagulants.
        Blood Rev. 2017; 31: 77-84
        • Horlocker T.T.
        • Vandermeuelen E.
        • Kopp S.L.
        • et al.
        Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: american society of regional anesthesia and pain medicine evidence-based guidelines (Fourth Edition).
        Reg Anesth Pain Med. 2018; 43: 263-309
        • Narouze S.
        • Benzon H.T.
        • Provenzano D.
        • et al.
        Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition): guidelines from the american society of regional anesthesia and pain medicine, the european society of regional anaesthesia and pain therapy, the american academy of pain medicine, the international neuromodulation society, the north american neuromodulation society, and the world institute of pain.
        Reg Anesth Pain Med. 2018; 43: 225-262
        • Doherty J.U.
        • Gluckman T.J.
        • Hucker W.J.
        • et al.
        2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: a report of the american college of cardiology clinical expert consensus document task force.
        J Am Coll Cardiol. 2017; 69: 871-898
        • Tomaselli G.F.
        • Mahaffey K.W.
        • Cuker A.
        • et al.
        2020 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants: a report of the american college of cardiology solution set oversight committee.
        J Am Coll Cardiol. 2020; 76: 594-622
        • Spyropoulos A.C.
        • Douketis J.D.
        How I treat anticoagulated patients undergoing an elective procedure or surgery.
        Blood. 2012; 120: 2954-2962
        • Navas-Blanco J.R.
        • Martini A.
        • Fabbro 2nd, M.
        Expert consensus decision pathway of the american college of cardiology on management of bleeding in patients with oral anticoagulants: a review of the 2020 update for perioperative physicians.
        J Cardiothorac Vasc Anesth. 2021; 35: 2471-2479
        • Levy J.H.
        • Connors J.M.
        • Steiner M.E.
        • et al.
        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.
        Res Pract Thromb Haemost. 2020; 4: 562-568
        • Burnett A.E.
        • Mahan C.E.
        • Vazquez S.R.
        • et al.
        Guidance for the practical management of the direct oral anticoagulants (DOACs) in VTE treatment.
        J Thromb Thrombolysis. 2016; 41: 206-232
        • Franchini M.
        • Lippi G.
        Prothrombin complex concentrates: an update.
        Blood Transfus. 2010; 8: 149-154
        • Smith M.M.
        • Ashikhmina E.
        • Brinkman N.J.
        • et al.
        Perioperative use of coagulation factor concentrates in patients undergoing cardiac surgery.
        J Cardiothorac Vasc Anesth. 2017; 31: 1810-1819
        • Scharman C.D.
        • Shatzel J.J.
        • Kim E.
        • et al.
        Off-label use of 4-factor prothrombin complex concentrate is common despite little known benefit: a retrospective study.
        Eur J Haematol. 2018; 101: 349-353
        • Levy J.H.
        • Moore K.T.
        • Neal M.D.
        • et al.
        Rivaroxaban reversal with prothrombin complex concentrate or tranexamic acid in healthy volunteers.
        J Thromb Haemost. 2018; 16: 54-64
        • Majeed A.
        • Agren A.
        • Holmstrom M.
        • et al.
        Management of rivaroxaban- or apixaban-associated major bleeding with prothrombin complex concentrates: a cohort study.
        Blood. 2017; 130: 1706-1712
        • Marcos-Jubilar M.
        • Garcia Erce J.A.
        • Martinez-Calle N.
        • et al.
        Safety and effectiveness of a prothrombin complex concentrate in approved and off-label indications.
        Transfus Med. 2019; 29: 268-274
        • Schulman S.
        • Gross P.L.
        • Ritchie B.
        • et al.
        Prothrombin complex concentrate for major bleeding on factor Xa inhibitors: a prospective cohort study.
        Thromb Haemost. 2018; 118: 842-851
        • Castillo R.
        • Chan A.
        • Atallah S.
        • et al.
        Treatment of adults with intracranial hemorrhage on apixaban or rivaroxaban with prothrombin complex concentrate products.
        J Thromb Thrombolysis. 2021; 51: 151-158
        • Santibanez M.
        • Lesch C.A.
        • Lin L.
        • et al.
        Tolerability and effectiveness of 4-factor prothrombin complex concentrate (4F-PCC) for warfarin and non-warfarin reversals.
        J Crit Care. 2018; 48: 183-190
        • Milioglou I.
        • Farmakis I.
        • Neudeker M.
        • et al.
        Prothrombin complex concentrate in major bleeding associated with DOACs; an updated systematic review and meta-analysis.
        J Thromb Thrombolysis. 2021; 52: 1137-1150
        • Connolly S.J.
        • Crowther M.
        • Eikelboom J.W.
        • et al.
        Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors.
        N Engl J Med. 2019; 380: 1326-1335
        • Barra M.E.
        • Das A.S.
        • Hayes B.D.
        • et al.
        Evaluation of andexanet alfa and four-factor prothrombin complex concentrate (4F-PCC) for reversal of rivaroxaban- and apixaban-associated intracranial hemorrhages.
        J Thromb Haemost. 2020; 18: 1637-1647
        • Stevens V.M.
        • Trujillo T.C.
        • Kiser T.H.
        • et al.
        Retrospective Comparison of Andexanet Alfa and 4-Factor Prothrombin Complex for Reversal of Factor Xa-Inhibitor Related Bleeding.
        Clin Appl Thromb Hemost. 2021; 27 (10760296211039020)
        • Lipari L.
        • Yang S.
        • Milligan B.
        • et al.
        Emergent reversal of oral factor Xa inhibitors with four-factor prothrombin complex concentrate.
        Am J Emerg Med. 2020; 38: 2641-2645
        • Frontera J.A.
        • Bhatt P.
        • Lalchan R.
        • et al.
        Cost comparison of andexanet versus prothrombin complex concentrates for direct factor Xa inhibitor reversal after hemorrhage.
        J Thromb Thrombolysis. 2020; 49: 121-131
        • Gomez-Outes A.
        • Alcubilla P.
        • Calvo-Rojas G.
        • et al.
        Meta-analysis of reversal agents for severe bleeding associated with direct oral anticoagulants.
        J Am Coll Cardiol. 2021; 77: 2987-3001
        • Milling T.J.
        • Pollack C.V.
        A review of guidelines on anticoagulation reversal across different clinical scenarios - Is there a general consensus?.
        Am J Emerg Med. 2020; 38: 1890-1903
        • Levy J.H.
        • Faraoni D.
        • Spring J.L.
        • et al.
        Managing new oral anticoagulants in the perioperative and intensive care unit setting.
        Anesthesiology. 2013; 118: 1466-1474
        • Flaherty D.
        • Connors J.M.
        • Singh S.
        • et al.
        Andexanet alfa for urgent reversal of apixaban before aortic surgery requiring cardiopulmonary bypass: a case report.
        A A Pract. 2019; 13: 271-273
        • Levy J.H.
        • Welsby I.
        Andexanet alfa use in patients requiring cardiopulmonary bypass: quo vadis?.
        A A Pract. 2019; 13: 477
        • Di Nisio M.
        • Middeldorp S.
        • Buller H.R.
        Direct thrombin inhibitors.
        N Engl J Med. 2005; 353: 1028-1040
        • Weitz J.I.
        • Eikelboom J.W.
        • Samama M.M.
        New antithrombotic drugs: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of chest physicians evidence-based clinical practice guidelines.
        Chest. 2012; 141: e120S-e151S
        • Lemay A.
        • Kaye A.D.
        • Urman R.D.
        Novel anticoagulant agents in the perioperative setting.
        Anesthesiol Clin. 2017; 35: 305-313
        • Escobar C.
        • Barrios V.
        • Lip G.Y.H.
        • et al.
        Effectiveness and safety of dabigatran compared to Vitamin K antagonists in non-asian patients with atrial fibrillation: a systematic review and meta-analysis.
        Clin Drug Investig. 2021; 41: 941-953
        • Hauel N.H.
        • Nar H.
        • Priepke H.
        • et al.
        Structure-based design of novel potent nonpeptide thrombin inhibitors.
        J Med Chem. 2002; 45: 1757-1766
        • Weitz J.I.
        • Crowther M.
        Direct thrombin inhibitors.
        Thromb Res. 2002; 106: V275-V284
        • Bliden K.P.
        • Chaudhary R.
        • Mohammed N.
        • et al.
        Determination of non-Vitamin K oral anticoagulant (NOAC) effects using a new-generation thrombelastography TEG 6s system.
        J Thromb Thrombolysis. 2017; 43: 437-445
        • Schulman S.
        • Carrier M.
        • Lee A.Y.
        • et al.
        Perioperative management of dabigatran: a prospective cohort study.
        Circulation. 2015; 132: 167-173
        • Narouze S.
        • Benzon H.T.
        • Provenzano D.A.
        • et al.
        Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications: guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.
        Reg Anesth Pain Med. 2015; 40: 182-212
        • Pollack Jr., C.V.
        • Reilly P.A.
        • van Ryn J.
        • et al.
        Idarucizumab for dabigatran reversal - full cohort analysis.
        N Engl J Med. 2017; 377: 431-441
        • Levy J.H.
        • van Ryn J.
        • Sellke F.W.
        • et al.
        Dabigatran reversal with idarucizumab in patients requiring urgent surgery: a subanalysis of the RE-VERSE AD Study.
        Ann Surg. 2021; 274: e204-e211
        • Diaz M.Q.
        • Borobia A.M.
        • Nunez M.A.
        • et al.
        Use of prothrombin complex concentrates for urgent reversal of dabigatran in the Emergency Department.
        Haematologica. 2013; 98: e143-e144
        • Schulman S.
        • Ritchie B.
        • Goy J.K.
        • et al.
        Activated prothrombin complex concentrate for dabigatran-associated bleeding.
        Br J Haematol. 2014; 164: 308-310
        • Ghadimi K.
        • Levy J.H.
        • Welsby I.J.
        Prothrombin complex concentrates for bleeding in the perioperative setting.
        Anesth Analg. 2016; 122: 1287-1300