Management of novel oral anticoagulants in emergency and trauma surgery.
BACKGROUND
The compelling safety, efficacy and predictable effect of novel oral anticoagulants (NOACs) is driving a rapid expansion in their therapeutic indications. Management of the increasing number of patients on those new agents in the setting of emergency or trauma surgery can be challenging and the absence of specific reversal agents has been a matter of concern. This review summarises the key principles that underpin the management of those patients with a particular emphasis on the recent development of specific antidotes.


RESULTS
As of 2015, a new line of antidotes, specific for these drugs, are at different stages of their development with their release imminent. However, as NOACs are innately reversible due to their short half-life, the use of reversal agents will probably be restricted to a few exceptional cases. Post-marketing surveillance will be paramount to better clarify the role of these promising drugs.


CONCLUSIONS
Management of patients on NOACs in the context of emergency or trauma surgery relies on best supportive care in combination with the blood products and/or specific antidotes as required. Familiarity with the new reversal agents is essential but further evidence on their indications, safety and efficacy as well as consensus guidelines are warranted prior to widespread adoption.
Department of Vascular Surgery, University Hospital of South Manchester, UK.
Ana-Catarina
AC
Pinho-Gomes
Department of Vascular Surgery, University Hospital of South Manchester, UK.
Adam
A
Hague
Department of Vascular Surgery, University Hospital of South Manchester, UK. Electronic address: jonathan.ghosh@nhs.net.
Jonathan
J
Ghosh
D000284:Administration, Oral; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D000931:Antidotes / Q000008:administration & dosage; D001120:Arginine / Q000008:administration & dosage / Q000031:analogs & derivatives; D001779:Blood Coagulation Factors / Q000008:administration & dosage*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D010879:Piperazines / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D011322:Primary Prevention / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery*
D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D000931:Antidotes; D001779:Blood Coagulation Factors; D010879:Piperazines; D001120:Arginine; C000594745:idarucizumab; C000593571:PER977
Antidotes; Emergency surgery; Novel oral anticoagulants; Reversal agents; Trauma