Management of patients on Non-Vitamin K antagonist oral anticoagulants in the acute care and periprocedural setting

Amish N. Raval, Joaquin E. Cigarroa, Mina K. Chung, Larry J. Diaz-Sandoval, Deborah Diercks, Jonathan P. Piccini, Hee Soo Jung, Jeffrey B. Washam, Babu G. Welch, Allyson R. Zazulia, Sean P. Collins

    Research output: Contribution to journalArticle

    116 Scopus citations

    Abstract

    Non-Vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Knowledge of time of last ingestion of the NOAC and renal function is critical to managing these patients given that laboratory measurement is challenging because of the lack of commercially available assays in the United States. Idarucizumab is available as an antidote to rapidly reverse the effects of dabigatran. At present, there is no specific antidote available in the United States for the oral factor Xa inhibitors. Prothrombin concentrate may be considered in life-Threatening bleeding. Healthcare institutions should adopt a NOAC reversal and perioperative management protocol developed with multidisciplinary input.

    Original languageEnglish (US)
    Pages (from-to)e604-e633
    JournalCirculation
    Volume135
    Issue number10
    DOIs
    StatePublished - Feb 6 2017

    Keywords

    • AHA Scientific Statements
    • Acute care
    • Anticoagulants
    • Non-Vitamin K antagonist
    • Periprocedural

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)

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  • Cite this

    Raval, A. N., Cigarroa, J. E., Chung, M. K., Diaz-Sandoval, L. J., Diercks, D., Piccini, J. P., Jung, H. S., Washam, J. B., Welch, B. G., Zazulia, A. R., & Collins, S. P. (2017). Management of patients on Non-Vitamin K antagonist oral anticoagulants in the acute care and periprocedural setting. Circulation, 135(10), e604-e633. https://doi.org/10.1161/CIR.0000000000000477