title: [Perioperative management of new oral anticoagulants].
abstract: New oral anticoagulants do represent a major step forward as compared to low molecular weight heparins and vitamin K antagonists. Several issues deserve attention regarding their perioperative management. Three (and very soon four or five) active molecules are available on the market, adding to the major intra- and inter-individual variability, to the high number of drug-drug interactions, and to the interferences of renal function and many other parameters. New tests are available including the diluted thrombin time for dabigatran and a specific anti-Xa test for rivaroxaban and apixaban. No antidote is approved yet. Scheduled surgery: the safest suggestion is to mimic the perioperative management of vitamin K antagonist, with a 5-day interruption and low molecular weight heparin bridging whenever necessary. Emergency procedures: several suggestions issued from the Groupe d'Intérêt en Hémostase Péri-opératoire are proposed.
authors.affiliation: Groupe hospitalier Cochin-Broca-Hôtel-Dieu, service d'anesthésie-réanimation, 75014 Paris, France. Electronic address: marc.samama@cch.aphp.fr.
authors.forename: Charles-Marc
authors.initials: CM
authors.lastname: Samama
authors.affiliation: CHU de Grenoble, médecine vasculaire, 38043 Grenoble cedex 9, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Pernod
authors.affiliation: CHU de Grenoble, pôle d'anesthésie-réanimation, 38043 Grenoble cedex 9, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Albaladejo
authors.affiliation: CHU de Toulouse, laboratoire d'hématologie, 31059 Toulouse cedex, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Sie
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D004334:Drug Administration Schedule; D057915:Drug Substitution; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D013923:Thromboembolism / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K