An increasing number of patients on systemic oral anticoagulants present for cardiac
surgery, and cardiac anesthesiologists should be well-informed on their management
in the perioperative period. Direct oral anticoagulants (DOACs), including factor
Xa inhibitors and direct thrombin inhibitors, are an attractive alternative to warfarin
due to fewer dietary and drug interactions, less frequent monitoring requirements,
and an improved patient adherence. Since the approval of DOACs by the Food and Drug
Administration in 2010, the number of patients on these medications only has increased.
The guidelines vary on the periprocedural management of DOACs for cardiac surgery.
This review evaluated the current evidence for medication cessation before surgery,
based on timing as well as plasma drug concentration. The practice recommendations
of various monitoring tests and new evolving point-of-care testing are examined herein.
The different reversal agents were discussed by the authors for both elective and
urgent procedures. The cardiac anesthesiologist needs to be intimately familiar with
the management and current best practices of DOACs for safe and appropriate patient
care.
Key Words
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Article info
Publication history
Published online: July 18, 2022
Footnotes
☆Funding received from National Institutes of Health, NHLBI K23 HL153836-01A1 (LQR). Funding was used in the analysis, and interpretation of data and in writing the manuscript.
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