title: [Management of direct oral anticoagulants for invasive procedures].
abstract: Three new Direct Oral Anticoagulants (DOACs), rivaroxaban, apixaban and dabigatran etexilate are available on the French market. Management of DOAC-induced bleeding risk remains challenging. For elective procedures with high hemorrhagic risk, a last DOAC intake five days before procedure ensures complete elimination in all patients. Heparin bridging therapy should be proposed only to patients at high thrombotic risk. For elective procedures with low hemorrhagic risk, the DOAC intake of the night before procedure should be omitted. For urgent procedures with high bleeding risk, DOAC plasmatic concentration can be helpful: concentration lower than 30 ng/mL should enable performing the procedure; a high concentration is associated with a higher bleeding risk, especially if higher than 400 ng/mL. In case of massive bleeding, no antidote is approved yet; activated prothrombin concentrates or non-activated 4-factors prothrombin concentrates could be considered.
authors.affiliation: Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France; Inserm UMR-S1140, université Paris-Descartes, Sorbonne Paris-Cité, 75006 Paris, France. Electronic address: agodier@fo-rothschild.fr.
authors.forename: A
authors.initials: A
authors.lastname: Godier
authors.affiliation: Inserm UMR-S1140, université Paris-Descartes, Sorbonne Paris-Cité, 75006 Paris, France; Laboratoire d'hématologie, groupe hospitalier Cochin-Hôtel-Dieu, AP-HP, 75014 Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Gouin-Thibault
authors.affiliation: Service d'anesthésie-réanimation, groupe hospitalier Cochin-Hôtel-Dieu, AP-HP, 75014 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Rosencher
authors.affiliation: Pôle d'anesthésie-réanimation, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Albaladejo
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D003663:Decision Trees; D006470:Hemorrhage; D006801:Humans; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000628:therapy*; D018570:Risk Assessment; D013514:Surgical Procedures, Operative
chemical_list: D000925:Anticoagulants
keywords: Antagonisation; Anticoagulant; Antidote; Bleeding; Chirurgie; Hémorragie; Reversal; Surgery