Perioperative Management of Patients Receiving New Anticoagulants.

摘要: There is an increased use of oral anticoagulants for the prevention venous and arterial thrombosis. Vitamin-K antagonists have been used decades as main but they draback a complex therapeutic management, slow onset action by different intake caused dietary vitamin K intake. New non-vitamin antagonist (NOACs) developed to overcome limitations warfarin. Their management easier it requires fixed daily dose without coagulation monitoring. Although their profile safe, proper attention should be paid in case unexpected need reversal effect patient needs scheduled surgery. For non-acute cardiac surgery, discontinuation NOACs start at least 48 hours prior Intracranial bleedings associated with are less dangerous comparing those warfarin-induced. stopped ≥24 elective surgery low bleeding-risk procedures ≥48 high patients normal renal function 72 reduced CrCl < 80. The therapy resumed from after procedure depending on perceived bleeding, type thrombotic risks. some available NOAC agents acting within 5 20 minutes. In lack agent, adequate diuresis, replacement activated charcoal recent ingestion considered.