title: [Recommendations on use of direct oral anticoagulants in the perioperative period].
abstract: Because of the characteristics of direct oral anticoagulants (DOA), the lack of an antidote to completely reverse their anticoagulant effects, the absence of standardization in monitoring of their effects, and limited experience of their use, specific recommendations for their management in the perioperative period or in emergencies are required. In elective surgery, in patients with normal renal function and low hemorrhagic/ thrombotic risk, DOA should be withdrawn 2 days before the intervention; when the hemorrhagic/ thrombotic risk is higher, bridge therapy with a low molecular weight hepatin beginning 5 days before the intervention is proposed as an alternative. In emergency surgery, systematic administration of hemostatic drugs as prophylaxis is not recommended. In DOA-related acute hemorrhage, administration of prothrombin complex concentrate, fresh plasma or factor VIIa should be evaluated, and general measures to control bleeding should be implemented.
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Universidad Católica San Vicente Mártir, Valencia, España. juanvllau@gmail.com
authors.forename: Juan V
authors.initials: JV
authors.lastname: Llau
authors.forename: Raquel
authors.initials: R
authors.lastname: Ferrandis
authors.forename: Jorge
authors.initials: J
authors.lastname: Castillo
authors.forename: José
authors.initials: J
authors.lastname: de Andrés
authors.forename: Carmen
authors.initials: C
authors.lastname: Gomar
authors.forename: Aurelio
authors.initials: A
authors.lastname: Gómez-Luque
authors.forename: Francisco
authors.initials: F
authors.lastname: Hidalgo
authors.forename: Luis M
authors.initials: LM
authors.lastname: Torres
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D000069604:Dabigatran; D006801:Humans; D009025:Morpholines / Q000009:adverse effects / Q000627:therapeutic use; D019990:Perioperative Care / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use; D011728:Pyridones / Q000009:adverse effects / Q000627:therapeutic use; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use; D054556:Venous Thromboembolism / Q000517:prevention & control*; D028761:Withholding Treatment; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran