Document Detail

Managing new oral anticoagulants in the perioperative and intensive care unit setting.
MedLine Citation:
PMID:  23416382     Owner:  NLM     Status:  MEDLINE    
Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with any anticoagulant (including the known principles for warfarin) should be considered. This review summarizes the available data regarding the management of bleeding with novel oral anticoagulation agents. Hemodialysis is a therapeutic option for dabigatran-related bleeding, while in vitro studies showed that prothrombin complex concentrates are reported to be useful for rivaroxaban-related bleeding. Additional clinical studies are needed to determine the best method for reversal of the novel oral anticoagulation agents when bleeding occurs.
Jerrold H Levy; David Faraoni; Jenna L Spring; James D Douketis; Charles M Samama
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Anesthesiology     Volume:  118     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-22     Completed Date:  2013-07-22     Revised Date:  2014-02-18    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1466-74     Citation Subset:  AIM; IM    
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MeSH Terms
Administration, Oral
Anticoagulants / adverse effects*
Benzimidazoles / adverse effects
Hemorrhage / chemically induced*,  prevention & control*
Intensive Care / methods*
Intensive Care Units
Morpholines / adverse effects
Perioperative Care / methods*
Pyrazoles / adverse effects
Pyridones / adverse effects
Thiophenes / adverse effects
Warfarin / adverse effects
beta-Alanine / adverse effects,  analogs & derivatives
Reg. No./Substance:
0/Anticoagulants; 0/Benzimidazoles; 0/Morpholines; 0/Pyrazoles; 0/Pyridones; 0/Thiophenes; 0/rivaroxaban; 11P2JDE17B/beta-Alanine; 3Z9Y7UWC1J/apixaban; 5Q7ZVV76EI/Warfarin; I0VM4M70GC/dabigatran
Comment In:
Anesthesiology. 2014 Jan;120(1):242-3   [PMID:  24398743 ]
Anesthesiology. 2014 Jan;120(1):243   [PMID:  24398744 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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