Peri-Procedural Management of Oral Anticoagulants in the DOAC Era

Peri-procedural management of oral anticoagulants can be complex and confusing for many providers. It involves a careful balance of a patient's thromboembolic risk and bleeding risk. For every patient chronically taking an oral anticoagulant who will be undergoing an elective procedure, a four step approach may be considered when creating a plan for the oral anticoagulant.(Writing Group M, 20161) Does the oral anticoagulant need to stop for the procedure?(Periprocedural Management of Anticoagulation Writing C, Doherty JU, Gluckman TJ, et al., 20172) If yes, when should the oral anticoagulant be stopped pre-procedure?(Douketis et al., 20153) Does the patient require a “bridging” parenteral anticoagulant?(Douketis et al., 20124) When should anticoagulation be re-started post procedure? Based on the unique features of warfarin versus the direct oral anticoagulants (DOAC), a unique, personalized plan should be developed and tailored to the individual patient.
Source: Progress in Cardiovascular Diseases - Category: Cardiology Authors: Source Type: research