title: Managing new oral anticoagulants in the perioperative and intensive care unit setting.
abstract: Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with any anticoagulant (including the known principles for warfarin) should be considered. This review summarizes the available data regarding the management of bleeding with novel oral anticoagulation agents. Hemodialysis is a therapeutic option for dabigatran-related bleeding, while in vitro studies showed that prothrombin complex concentrates are reported to be useful for rivaroxaban-related bleeding. Additional clinical studies are needed to determine the best method for reversal of the novel oral anticoagulation agents when bleeding occurs.
authors: Department of Anesthesiology/Critical Care, Duke University School of Medicine, Durham, North Carolina 27710, USA. docmd2@yahoo.com
authors: Jerrold H
authors: JH
authors: Levy
authors: David
authors: D
authors: Faraoni
authors: Jenna L
authors: JL
authors: Spring
authors: James D
authors: JD
authors: Douketis
authors: Charles M
authors: CM
authors: Samama
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects*; D001562:Benzimidazoles / Q000009:adverse effects; D003422:Critical Care / Q000379:methods*; D000069604:Dabigatran; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units; D009025:Morpholines / Q000009:adverse effects; D019990:Perioperative Care / Q000379:methods*; D011720:Pyrazoles / Q000009:adverse effects; D011728:Pyridones / Q000009:adverse effects; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects; D014859:Warfarin / Q000009:adverse effects; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran