To measure or not to measure direct oral anticoagulants before surgery or invasive procedures.
Patients on direct oral anticoagulants (DOAC) may need interruption of treatment before surgery or invasive procedures. Owing to their favorable pharmacokinetics, DOAC could be interrupted for a fixed number of days before surgery or invasive procedures without laboratory testing. However, there are a number of issues that raise concerns about the safety of this strategy. In contrast, laboratory testing prior to surgery or invasive procedures would provide a direct assessment of the residual drug concentration and minimize the risk of bleeding. This forum is aimed at discussing the pros and cons of the two strategies and fostering discussion on this important issue. Overall, the laboratory strategy appears superior in terms of patient safety and should be considered in patients undergoing surgical or invasive procedures.
Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano and IRCCS Cà Granda Maggiore Hospital Foundation, Milan, Italy.
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Tripodi
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001780:Blood Coagulation Tests / Q000592:standards*; D065427:Factor Xa Inhibitors / Q000627:therapeutic use; D006470:Hemorrhage; D006801:Humans; D013058:Mass Spectrometry; D061214:Patient Safety; D057234:Preoperative Period; D011720:Pyrazoles / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use; D013917:Thrombin / Q000627:therapeutic use; D013918:Thrombin Time
D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011725:Pyridines; D011728:Pyridones; D013844:Thiazoles; C522181:apixaban; D000069552:Rivaroxaban; D013917:Thrombin; C552171:edoxaban
factor Xa; multiphasic screening; partial thromboplastin time; prothrombin time; thrombin time