NOACs in Anesthesiology.
Transfus Med Hemother
; 46(4): 282-293, 2019 Aug.
Article
em En
| MEDLINE
| ID: mdl-31700511
ABSTRACT
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.
Texto completo:
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Bases de dados:
MEDLINE
Tipo de estudo:
Guideline
Idioma:
En
Revista:
Transfus Med Hemother
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Suíça