Interrupting anticoagulation in patients with nonvalvular atrial fibrillation.

摘要: Three target-specific oral anticoagulants (TSOACs)-dabigatran, rivaroxaban, and apixaban-have been approved by the FDA to reduce risk of stroke systemic embolism in patients with nonvalvular atrial fibrillation; however, no agents are currently reverse anticoagulant effects these TSOACs cases active bleeding. This review discusses benefits risks from a clinician's perspective, focus on interruption treatment for either elective or emergent surgery, monitoring, reversal anticoagulation. Available coagulation assays not ideal monitoring do provide reliable quantitative measurement their effects. When necessary, activated partial thromboplastin time (aPTT) may qualitative information dabigatran, prothrombin (PT) assessment presence factor Xa inhibitors, rivaroxaban apixaban. Current recommendations based largely limited sometimes conflicting data vitro vivo animal models, clinical experience is also limited. Methods that have investigated effectiveness pharmacodynamic include dialysis, charcoal, complex concentrate (PCC), recombinant VII. It important note even within class drugs, compounds respond differently agents; therefore, one agent should be extrapolated another, if they same therapeutic class. New antidotes being explored, including mouse monoclonal antibody dabigatran; andexanet alfa, potential universal inhibitor agent; synthetic small molecule (PER977) effective inhibitors direct thrombin inhibitors. Given short half-lives TSOACs, watchful waiting, rather than reversal, best approach some circumstances.