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Semin Thromb Hemost 2017; 43(07): 706-715
DOI: 10.1055/s-0037-1602667
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Novel (Oral) Anticoagulant Challenges in Surgery

Richard Blennerhassett
1   Department of Laboratory Haematology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, NSW Health Pathology, Westmead, New South Wales, Australia
2   Sydney Medical School, University of Sydney, Westmead, New South Wales, Australia
,
Emmanuel J. Favaloro
1   Department of Laboratory Haematology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, NSW Health Pathology, Westmead, New South Wales, Australia
3   Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales Australia
,
Leonardo Pasalic
1   Department of Laboratory Haematology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, NSW Health Pathology, Westmead, New South Wales, Australia
3   Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales Australia
› Author Affiliations
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Publication History

Publication Date:
08 June 2017 (online)

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Summary

Non-vitamin K oral anticoagulants (NOACs) are a relatively recent therapeutic modality for the prevention of systemic thromboembolic complications of atrial fibrillation and the prevention and management of venous thromboembolic disease. Approved indications for this class of anticoagulants are likely to further expand as the results of ongoing and new clinical trials are published and clinical experience grows. Despite their convenience compared with traditional methods of anticoagulation, there remain a few potential pitfalls associated with their use in the perioperative setting. In particular, there is limited experience and evidence base regarding anticoagulant management in the perioperative setting, especially given the different NOACs available, which in turn are different from the classical anticoagulants. This narrative review synthesizes the recent advances in development of specific NOAC reversal agents and the understanding of the complexities of laboratory measurement of NOAC anticoagulant effects, and aims to provide practicing clinicians with basic evidence-based tools for perioperative management of patients taking NOACs.

Keywords

rivaroxaban - apixaban - dabigatran - perioperative - surgery - NOACs - anticoagulation