NOACs in Anesthesiology.
- Spahn DR Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
- Beer JH Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland.
- Borgeat A Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland.
- Chassot PG Formerly Department of Anesthesiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
- Kern C Department of Anesthesiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
- Mach F Department of Internal Medicine, University Hospitals of Geneva (HUG), Geneva, Switzerland.
- Nedeltchev K Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
- Korte W Center for Laboratory Medicine; Hemostasis and Hemophilia Center, St. Gallen, Switzerland.
- 2019-11-09
Published in:
- Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie. - 2019
English
Background
Due to increasing use of new oral anticoagulants (NOACs), clinicians are faced more and more frequently with clinical issues related to these drugs.
Objective
The objective of this publication is to make practical suggestions for the perioperative management of NOACs as well as for their handling in overdoses and bleedings.
Recommendations
In elective surgery and creatinine clearance ≥ 50 ml/min, a NOAC should be discontinued 24-36 h before the intervention, and even earlier in case of reduced kidney function. In emergency interventions that cannot be delayed, the management is dependent on the NOAC plasma levels. With levels ≤ 30 ng/ml, surgery can be performed. With levels >30 ng/ml, reversal agents should be considered. In low bleeding risk surgery, NOACs can be re-started 24 h after the intervention, which is prolonged to 48-72 h after surgery with high bleeding risk. In case of NOAC overdose and minor bleedings, temporary discontinuation and supportive care are usually sufficient to control the situation. In severe or life-threatening bleedings, nonspecific and specific reversal agents should be considered.
Due to increasing use of new oral anticoagulants (NOACs), clinicians are faced more and more frequently with clinical issues related to these drugs.
Objective
The objective of this publication is to make practical suggestions for the perioperative management of NOACs as well as for their handling in overdoses and bleedings.
Recommendations
In elective surgery and creatinine clearance ≥ 50 ml/min, a NOAC should be discontinued 24-36 h before the intervention, and even earlier in case of reduced kidney function. In emergency interventions that cannot be delayed, the management is dependent on the NOAC plasma levels. With levels ≤ 30 ng/ml, surgery can be performed. With levels >30 ng/ml, reversal agents should be considered. In low bleeding risk surgery, NOACs can be re-started 24 h after the intervention, which is prolonged to 48-72 h after surgery with high bleeding risk. In case of NOAC overdose and minor bleedings, temporary discontinuation and supportive care are usually sufficient to control the situation. In severe or life-threatening bleedings, nonspecific and specific reversal agents should be considered.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1159/000491400
- PMID 31700511
- Persistent URL
- https://sonar.ch/global/documents/236950
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