Abstract
Patients on anticoagulant treatment are constantly increasing, with an estimated prevalence
in Italy of 2% of the total population. About a quarter of the anticoagulated patients
require temporary cessation of direct oral anticoagulants (DOACs) or vitamin K antagonists
for a planned intervention within 2 years from anticoagulation inception. Several
clinical issues about DOAC interruption remain unanswered: many questions are tentatively
addressed daily by thousands of physicians worldwide through an experience-based balancing
of thrombotic and bleeding risks. Among possible valuable answers, the Italian Federation
of Centers for the diagnosis of thrombotic disorders and the Surveillance of the Antithrombotic
therapies (FCSA) proposes some experience-based suggestions and expert opinions. In
particular, FCSA provides practical guidance on the following issues: (1) multiparametric
assessment of thrombotic and bleeding risks based on patients' individual and surgical
risk factor, (2) testing of prothrombin time, activated partial thromboplastin time,
and DOAC plasma levels before surgery or invasive procedure, (3) use of heparin, (4)
restarting of full-dose DOAC after high risk bleeding surgery, (5) practical nonpharmacological
suggestions to manage patients perioperatively. Finally, FCSA suggests creating a
multidisciplinary “anticoagulation team” with the aim to define the optimal perioperative
management of anticoagulation.
Keywords direct oral anticoagulant - surgery - FCSA
