Management of direct oral anticoagulants for invasive procedures

Journal des maladies vasculaires
A GodierGroupe d’Intérêt en Hémostase Périopératoire

Abstract

Three new Direct Oral Anticoagulants (DOACs), rivaroxaban, apixaban and dabigatran etexilate are available on the French market. Management of DOAC-induced bleeding risk remains challenging. For elective procedures with high hemorrhagic risk, a last DOAC intake five days before procedure ensures complete elimination in all patients. Heparin bridging therapy should be proposed only to patients at high thrombotic risk. For elective procedures with low hemorrhagic risk, the DOAC intake of the night before procedure should be omitted. For urgent procedures with high bleeding risk, DOAC plasmatic concentration can be helpful: concentration lower than 30 ng/mL should enable performing the procedure; a high concentration is associated with a higher bleeding risk, especially if higher than 400 ng/mL. In case of massive bleeding, no antidote is approved yet; activated prothrombin concentrates or non-activated 4-factors prothrombin concentrates could be considered.

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Citations

Jun 15, 2016·Journal des maladies vasculaires·A GodierS Susen
Nov 5, 2016·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Sarah LessireFrançois Mullier
May 19, 2017·Thrombosis Journal·Virginie DuboisSarah Lessire
May 2, 2017·European Journal of Anaesthesiology·Sibylle A Kozek-LangeneckerKai Zacharowski

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