PDF icon Download PDF
Semin Thromb Hemost 2019; 45(02): 171-179
DOI: 10.1055/s-0039-1678719
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

To Maintain or Cease Non–Vitamin K Antagonist Oral Anticoagulants Prior to Minimal Bleeding Risk Procedures: A Review of Evidence and Recommendations

Yvonne Brennan
1   Department of Haematology, Westmead Hospital, Sydney, Australia
,
Emmanuel J. Favaloro
2   Diagnostic Haemostasis Laboratory, Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, Australia
3   Sydney Centres for Thrombosis and Haemostasis, Westmead, Australia
,
Jennifer Curnow
1   Department of Haematology, Westmead Hospital, Sydney, Australia
3   Sydney Centres for Thrombosis and Haemostasis, Westmead, Australia
4   Sydney Medical School, The University of Sydney, Sydney, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
11 February 2019 (online)

   Permissions and Reprints
Preview

Abstract

For procedures associated with minimal bleeding risk, there are data and experience to support the practice of continuing vitamin K antagonists rather than interrupting therapy, to prevent exposing patients to the undue risk of developing thromboembolism during anticoagulation cessation. Despite the increasing use of non–vitamin K oral anticoagulants (NOACs), there is little evidence to guide the management of these drugs around minimal bleeding risk procedures. This review examines and discusses the major society guidelines and recommendations addressing the management of NOACs around minimal bleeding risk procedures. Additionally, it summarizes the existing evidence, and highlights the gaps in knowledge where evidence is not yet available. Finally, recommendations are made to assist the proceduralist deal with this area of limited evidence.

Keywords

Non–vitamin K oral anticoagulants - direct oral anticoagulants - anticoagulation - surgery - minimal bleeding risk - dental procedure - dermatologic surgery

Statement of Limitations

As searches were limited to the PubMed database and the English language, we could not be certain that the search was all inclusive for all guidelines, or all the “minimal bleeding risk procedures” potentially covered, but as the search uncovered guidelines from the major societies, and a range of anticipated “minimal bleeding risk procedures” were covered, we believe the report to reflect a fair representation of the literature.