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.
References
Sep 4, 2008·Thrombosis and Haemostasis·Wolfgang MueckBengt I Eriksson
Dec 8, 2009·The New England Journal of Medicine·Sam SchulmanUNKNOWN RE-COVER Study Group
Jan 1, 2010·The New England Journal of Medicine·Donald Stuart Houston, Ryan Zarychanski
Mar 31, 2010·Thrombosis and Haemostasis·Joanne van RynAndreas Clemens
Jul 16, 2010·Thrombosis Research·Gilles PernodUNKNOWN French National Authority for Health
Nov 5, 2010·The New England Journal of Medicine·Marcel LeviDavid Truloff
Dec 7, 2010·The New England Journal of Medicine·Rupert BauersachsSebastian Schellong
Feb 12, 2011·The New England Journal of Medicine·Stuart J ConnollyUNKNOWN AVERROES Steering Committee and Investigators
Dec 14, 2011·Archives of Cardiovascular Diseases·Pierre SiéUNKNOWN French Study Group on Thrombosis and Haemostasis
Mar 28, 2012·The New England Journal of Medicine·Harry R BüllerAnnelise Segers
Jun 16, 2012·Circulation·Jeff S HealeyUNKNOWN RE-LY Investigators
Aug 23, 2012·Circulation·Deborah SiegalAlex C Spyropoulos
Dec 12, 2012·European Heart Journal·Deborah M Siegal, Mark A Crowther
Mar 5, 2013·Nature Medicine·Genmin LuUma Sinha
Mar 12, 2013·Blood·Felix SchieleTobias Litzenburger
Apr 23, 2013·Critical Care : the Official Journal of the Critical Care Forum·Donat R SpahnRolf Rossaint
Apr 30, 2013·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Hein HeidbuchelUNKNOWN European Heart Rhythm Association
Jul 3, 2013·Archives of Cardiovascular Diseases·Gilles PernodUNKNOWN Working Group on Perioperative Haemostasis
Nov 28, 2013·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Xiaoli WangCharles Frost
Jan 5, 2014·Blood·Deborah M SiegalMark A Crowther
Jan 8, 2014·European Heart Journal·Jan Beyer-WestendorfNorbert Weiss
Mar 29, 2014·Thrombosis Research·Frank M H LeeHoward H Chan
Jul 25, 2014·Thrombosis and Haemostasis·Thomas LehmannWolfgang Korte
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