title: Management of direct oral anticoagulants in patients undergoing elective surgeries and invasive procedures: Updated guidelines from the French Working Group on Perioperative Hemostasis (GIHP) - September 2015.
abstract: Since 2011, data on patients exposed to direct oral anticoagulants (DOAs) while undergoing invasive procedures have accumulated. At the same time, an increased hemorrhagic risk during perioperative bridging anticoagulation without thrombotic risk reduction has been demonstrated. This has led the GIHP to update their guidelines published in 2011. For scheduled procedures at low bleeding risk, it is suggested that patients interrupt DOAs the night before irrespective of type of drug and to resume therapy six hours or more after the end of the invasive procedure. For invasive procedures at high bleeding risk, it is suggested to interrupt rivaroxaban, apixaban and edoxaban three days before. Dabigatran should be interrupted according to the renal function, four days and five days if creatinine clearance is higher than 50mL/min and between 30 and 50mL/min, respectively. For invasive procedures at very high bleeding risk such as intracranial neurosurgery or neuraxial anesthesia, longer interruption times are suggested. Finally, bridging with parenteral anticoagulation and measurement of DOA concentrations can no longer routinely be used.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital, ThEMAS, TIMC, UMR, CNRS 5525, Université Grenoble-Alpes, 38043 Grenoble, France. Electronic address: palbaladejo@chu-grenoble.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Albaladejo
authors.affiliation: Division of Anesthesiology, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Fanny
authors.initials: F
authors.lastname: Bonhomme
authors.affiliation: Department de Medicine - University of Montréal, CHUM - Hôpital Notre-Dame, Montréal, Quebec, Canada.
authors.forename: Normand
authors.initials: N
authors.lastname: Blais
authors.affiliation: Univ Paris 06 (UPMC), ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (APHP), Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: Department of Anesthesiology, Peri-operative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA.
authors.forename: David
authors.initials: D
authors.lastname: Faraoni
authors.affiliation: Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fontana
authors.affiliation: Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Godier
authors.affiliation: Department of Anesthesiology and Critical Care. Hospital Clínic Universitari, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Llau
authors.affiliation: Département d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, University Paris Diderot, Sorbonne Paris Cité, U1148 INSERM, Paris, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Longrois
authors.affiliation: Department of Anesthesiology, American Hospital of Paris & Institut Hospitalier Franco-Britannique.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Marret
authors.affiliation: Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mismetti
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Cochin and Hôtel-Dieu University Hospitals, Paris Descartes University, Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Rosencher
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Cochin and Hôtel-Dieu University Hospitals, Paris Descartes University, Paris, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Roullet
authors.affiliation: Service d'Anesthésie Réanimation 1, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.
authors.forename: Charles-Marc
authors.initials: CM
authors.lastname: Samama
authors.affiliation: Department of Hematology, CHU Montpellier, Montpellier, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Schved
authors.affiliation: Department of Hematology, Toulouse University Hospital, Toulouse, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Sié
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital, Strasbourg, France.
authors.forename: Annick
authors.initials: A
authors.lastname: Steib
authors.affiliation: Department of Hematology and Transfusion, Lille University Hospital, Institut Pasteur de Lille, EGID, INSERM UMR 1011, University of Lille 2, Lille, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Susen
mesh_terms: D000772:Anesthesia, Local; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003404:Creatinine / Q000097:blood; D017558:Elective Surgical Procedures / Q000379:methods*; D005602:France; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007677:Kidney Function Tests; D008991:Monitoring, Physiologic; D019635:Neurosurgical Procedures; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000379:methods*; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D003404:Creatinine
keywords: Direct oral anticoagulants; Elective surgery; Periprocedural management