title: [Perioperative management of direct oral anticoagulant in emergency surgery and bleeding. Haemostasis monitoring and treatment].
abstract: There is an almost unanimous consensus on the management of the direct new oral anticoagulants, dabigatran, rivaroxaban, and apixaban in elective surgery. However, this general consensus does not exist in relation with the direct new oral anticoagulants use in emergency surgery, especially in the bleeding patient. For this reason, a literature review was performed using the MEDLINE-PubMed. An analysis was made of the journal articles, reviews, systematic reviews, and practices guidelines published between 2000 and 2014 using the terms "monitoring" and "reversal". From this review, it was shown that the routine tests of blood coagulation, such as the prothrombin time and activated partial thromboplastin time, have a limited efficacy in the perioperative control of blood coagulation in these patients. There is currently no antidote to reverse the effects of these drugs, although the possibility of using concentrated prothrombin complex and recombinant activated factor vii has been suggested for the urgent reversal of the anticoagulant effect.
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Clínica Universidad de Navarra, Pamplona, Navarra, España.
authors.forename: F
authors.initials: F
authors.lastname: Hidalgo
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, España. Electronic address: jagomez@uma.es.
authors.forename: A
authors.initials: A
authors.lastname: Gómez-Luque
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España.
authors.forename: R
authors.initials: R
authors.lastname: Ferrandis
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España.
authors.forename: J V
authors.initials: JV
authors.lastname: Llau
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Universidad de Valencia, Valencia, España.
authors.forename: J
authors.initials: J
authors.lastname: de Andrés
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
authors.forename: C
authors.initials: C
authors.lastname: Gomar
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Fundación Puigvert (IUNA), Barcelona, España.
authors.forename: P
authors.initials: P
authors.lastname: Sierra
authors.affiliation: Servicio de Anestesiología, Hospital del Mar, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Castillo
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Puerta del Mar, Cádiz, España.
authors.forename: L M
authors.initials: LM
authors.lastname: Torres
mesh_terms: D000284:Administration, Oral; D000991:Antithrombins / Q000008:administration & dosage / Q000627:therapeutic use*; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical; D016903:Drug Monitoring; D004630:Emergencies; D015942:Factor VIIa / Q000627:therapeutic use; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control*; D006489:Hemostatic Techniques; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000188:drug therapy / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D001779:Blood Coagulation Factors; D065427:Factor Xa Inhibitors; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; C103587:recombinant FVIIa; D015942:Factor VIIa
keywords: Anticoagulantes orales directos; Cirugía urgente; Complicaciones perioperatorias; Direct oral anticoagulants; Monitoring; Monitorización; Perioperative bleeding; Perioperative complications; Sangrado perioperatorio; Urgent surgery