Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association.
Non-vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Knowledge of time of last ingestion of the NOAC and renal function is critical to managing these patients given that laboratory measurement is challenging because of the lack of commercially available assays in the United States. Idarucizumab is available as an antidote to rapidly reverse the effects of dabigatran. At present, there is no specific antidote available in the United States for the oral factor Xa inhibitors. Prothrombin concentrate may be considered in life-threatening bleeding. Healthcare institutions should adopt a NOAC reversal and perioperative management protocol developed with multidisciplinary input.
Amish N
AN
Raval
Joaquin E
JE
Cigarroa
Mina K
MK
Chung
Larry J
LJ
Diaz-Sandoval
Deborah
D
Diercks
Jonathan P
JP
Piccini
Hee Soo
HS
Jung
Jeffrey B
JB
Washam
Babu G
BG
Welch
Allyson R
AR
Zazulia
Sean P
SP
Collins
D000572:American Heart Association; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use*; D000931:Antidotes / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D000069604:Dabigatran / Q000627:therapeutic use; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D014481:United States; D054556:Venous Thromboembolism / Q000188:drug therapy*
D061067:Antibodies, Monoclonal, Humanized; D000925:Anticoagulants; D000931:Antidotes; C000594745:idarucizumab; D000069604:Dabigatran
AHA Scientific Statements; acute care; anticoagulants; non–vitamin K antagonist; periprocedural