Perioperative Management of Patients Receiving New Oral Anticoagulants

Faraoni, David; Samama, Charles C.M.; Ranucci, Marco; Dietrich, Wulf; Levy, Jerrold J.H.

doi:10.1016/j.cll.2014.06.006

Cited by 25 publications

(20 citation statements)

References 27 publications

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“…To our knowledge, no systematic review and meta‐analysis has been conducted in human studies addressing reversal of DOACs. We have identified several narrative reviews, without a standardized approach, rigorous assessment of risk of biases, and heterogeneity between studies. Major limitations of this review are related to the limitations on the included studies.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of the drugs used to reverse direct oral anticoagulants: a systematic review and meta‐analysis

Luz¹,

Marchand

Nascimento³

et al. 2017

Transfusion

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of the drugs used to reverse direct oral anticoagulants: a systematic review and meta‐analysis

Luz¹,

Marchand

Nascimento³

et al. 2017

Transfusion

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“…Both in procedures with a low risk of haemorrhage and in those with a medium or high risk, local haemostatic measures must be taken (28-33). …”

Section: Resultsmentioning

confidence: 99%

Implications of apixaban for dental treatments

Curto

Albaladejo

2016

J Clin Exp Dent

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BackgroundAnticoagulation therapy is used in several conditions to prevent or treat thromboembolism. Recently, new oral anticoagulants have been introduced as alternatives to warfarin and acenocoumarol. In Europe, the European Medicines Agency has approved dabigatran, rivaroxaban and apixaban. Their advantages include: predictable pharmacokinetics, drug interactions and limited food, rapid onset of action and short half-life. However, they lack a specific reversal agent.Material and MethodsA literature search was conducted through November 2015 for publications in the ISI Web of Knowledge, PubMed, Scopus and Cochrane Library using the keywords “apixaban”, “rivaroxaban”, “dabigatran”, “new oral anticoagulants”, “dental treatment” and “dental implications”. We included studies published in English and Spanish over the last 10 years.ResultsApixaban has been recently introduced in the daily medical practices for the control of thromboembolism. The number of patients taking apixaban is increasing. Management of patients on anticoagulation therapy requires that dentists can accurately assess the patient prior to dental treatments. It is important for dentists to have a sound understanding of the mechanisms of action and management guidelines for patients taking new oral anticoagulants.ConclusionsThe dentist should consider carefully the management of patients on apixaban. This paper sets out a clinical guidance of dental practitioners treating these patients. There is a need for further clinical studies in order to establish more evidence-based guidelines for dental patients requiring apixaban. Key words:Apixaban, new oral anticoagulants, dental treatment.

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“…Protocols that are commonly in use for NOACs are mostly for routine perioperative period [54]. Currently no consensual guidelines for management of patients on NOACs achieved in emergent surgery settings.…”

Section: Discussionmentioning

confidence: 99%

Sessile Serrated Adenoma of the Appendix and Perforated Cecal Lymphoma in a Nonagenarian on Novel Anticoagulant Undergoing Emergent Surgery: The Challenges, Decision Making and Management of a Rare Case

2018

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A 92-year-old male with significant past medical history of atrial fibrillation, congenital heart disease, coronary artery disease (CAD), deep vein thrombosis (DVT), hyperlipidemia (HLD), hypertension (HTN), myocardial infarction (MI), and peripheral vascular disease presented to emergency department (ED) with shortness of breath and right sided chest pain. He was hypotensive and tachycardic with right upper and lower quadrant tenderness on clinical examination. Initial pulmonary embolism (PE) protocol CT scan was negative for pulmonary embolism but revealed a large 13 cm mass in right lower quadrant (RLQ) with adjacent free peritoneal air and fluid, suspicious for perforated cecal neoplasm or abscess. He received activated prothrombin complex concentrate (PCC) for emergent reversal of apixaban and taken emergently for exploratory laparotomy, where he underwent an extended right hemicolectomy with end ileostomy and a long Hartmann's. The ileocecal lesion was large and extended from the terminal ileum to almost the hepatic flexure. Histopathology revealed high-grade B-cell lymphoma involving the terminal ileum, cecum, ascending colon, appendix, and mesenteric lymph nodes. The specimen also contained a serrated sessile appendicular adenoma. We discuss urgent/emergent surgeries in nonagenarians with multiple comorbidities on novel oral anticoagulant (NOAC) as well as the indications of palliative surgery in these patient groups. We also discuss synchronous serrated adenoma along with the perforated high-grade lymphoma in the same patient.

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Perioperative Management of Patients Receiving New Oral Anticoagulants

Cited by 25 publications

References 27 publications

Efficacy and safety of the drugs used to reverse direct oral anticoagulants: a systematic review and meta‐analysis

Efficacy and safety of the drugs used to reverse direct oral anticoagulants: a systematic review and meta‐analysis

Implications of apixaban for dental treatments

Sessile Serrated Adenoma of the Appendix and Perforated Cecal Lymphoma in a Nonagenarian on Novel Anticoagulant Undergoing Emergent Surgery: The Challenges, Decision Making and Management of a Rare Case

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