title: Perioperative Management of the Direct Oral Anticoagulants: A Case-Based Review.
abstract: The periprocedural management of patients on direct oral anticoagulants (DOACs) is a common but potentially challenging clinical problem because there are few prospective studies to guide clinical decisions. Retrospective analyses from randomized trials and observational data suggest that DOACs can be managed in a standardized manner, based on surgical and patient characteristics, that does not result in excess major bleeding or thrombosis. In a case-based manner, this article presents a perioperative DOAC management algorithm and reviews the available and emerging evidence supporting the safety and efficacy of this approach. A free online clinical guidance tool is available from Thrombosis Canada that includes the proposed management algorithm.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada. Electronic address: ben.bell@nygh.on.ca.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Bell
authors.affiliation: Anticoagulation Services and Clinical Thrombosis Services, Northwell Health Systems at Lenox Hill Hospital, Hofstra Northwell School of Medicine, 130 E, 77th St., New York, NY 10075, USA.
authors.forename: Alex C
authors.initials: AC
authors.lastname: Spyropoulos
authors.affiliation: Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, St. Joseph's Hospital, 50 Charlton Avenue East, Room F-544, Hamilton, ON L8N 4A6, Canada.
authors.forename: James D
authors.initials: JD
authors.lastname: Douketis
mesh_terms: D000284:Administration, Oral; D000465:Algorithms; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013927:Thrombosis / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Algorithm; Direct oral anticoagulants; Perioperative management; Thrombosis