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Oral Anticoagulation Reversal Learning Zone

Updates in the perioperative and emergency management of non-vitamin K antagonist oral anticoagulants

Read time: 1 mins
Last updated:12th Mar 2020
Published:12th Feb 2020
This paper discusses the difficulties and complications involved when patients treated with non-vitamin K oral anticoagulants (NOACs) undergo planned or emergency surgical procedures. The authors examine the evidence about the management strategies used in clinical practice, and propose an algorithm to assist physicians in planning their strategy when a patient receiving NOAC therapy requires surgery.

The planned procedure should be classified in terms of the bleeding risk (none, low or high) and consideration should be given to the patient’s age and renal function, as both of these can influence the clearance of the anticoagulant. Patients prescribed NOAC therapy to reduce the risk of thrombosis can resume therapy after a suitable period of post-procedure haemostasis has been established, but should be delayed sufficiently to ensure that the risk of post-operative bleeding has passed. Where specific reversal agents for individual NOAC therapies are not available, the authors suggest that prothrombin complex concentrates (either non-activated four-factor or activated) are effective in controlling intra-operative bleeding during surgery.