[New oral anticoagulants. Consequences for perioperative coagulation diagnostics and therapy].
Dabigatranetexilate and rivaroxaban were approved for prevention of thromboembolic events after orthopedic surgery in 2008. Dabigatran is a direct inhibitor of thrombin and rivaroxaban of factor Xa. Inhibition is reversible and the duration of action is predictable. Both drugs considerably influence the global tests of coagulation thus making postoperative coagulation monitoring more difficult. In order to keep the interaction as low as possible blood samples for assessment of the thromboplastin time (PT) and the partial thromboplastin time (PTT) should be taken immediately before the next drug administration. Blood sampling about 2-4 h after drug administration can be performed to check the efficacy of drug action. Non-urgent operations should be started earliest 24 h after the previous drug application. In cases of emergency interventions due to life-threatening bleeding, administration of prothrombin complex concentrate might be a successful treatment option. Specific antidotes are not available.
Heindl
B
B
Arbeitsgruppe Perioperative Haemostase, Klinik für Anaesthesiologie, Klinikum der Universität München, 80336 München. Bernhard.Heindl@med.uni-muenchen.de
Spannagl
M
M
D000284:Administration, Oral; D000925:Anticoagulants / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D000069604:Dabigatran; D065427:Factor Xa Inhibitors; D006801:Humans; D019934:International Normalized Ratio; D007431:Intraoperative Complications / Q000517:prevention & control*; D009025:Morpholines / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010314:Partial Thromboplastin Time; D011725:Pyridines / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000069552:Rivaroxaban; D013876:Thiophenes / Q000493:pharmacokinetics / Q000627:therapeutic use*; D013917:Thrombin / Q000037:antagonists & inhibitors; D013923:Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants; D001562:Benzimidazoles; D065427:Factor Xa Inhibitors; D009025:Morpholines; D011725:Pyridines; D013876:Thiophenes; D000069552:Rivaroxaban; D013917:Thrombin; D000069604:Dabigatran