One discussion this week focused on the perioperative management of NOACs.
Reference: DynaMed Plus [Internet]. Ipswich (MA): EBSCO Information Services. 1995 -. Record No. 227537, Periprocedural management of patients on long-term anticoagulation; [updated 2018 Oct 10, cited 2018 Oct 12; [about 26 screens]. Emory login required.
Summary: The information below is from DynaMed Plus (2018). To view full information on the topic, click on the citation above.
Vitamin K antagonists in patients undergoing major surgery or procedures
- Consider continuing vitamin K antagonist (VKA) therapy in patients who require minor dental procedures, minor dermatological procedures, or cataract surgery.
- In those having a minor dental procedure, consider coadministering an oral hemostatic agent or stopping the VKA 2 to 3 days before the procedure.
- In those undergoing implantation of a pacemaker or an implantable cardioverter device, consider continuing VKA therapy.
- In those having a major surgery or procedure, stop VKA therapy 5 days before surgery.
- Resume VKA therapy 12-24 hours after surgery when there is adequate hemostasis.
Bridging therapy in patients undergoing major surgery or procedures
- If at low risk for thrombosis, consider omitting bridging therapy.
- If at moderate risk for thrombosis, assess individual patient- and surgery-related factors when considering bridging therapy.
- If at high risk for thrombosis consider bridging therapy with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH).
- For those receiving bridging therapy with UFH, stop UFH 4-6 hours before surgery.
- For those receiving bridging therapy with therapeutic-dose LMWH, stop LMWH 24 hours before surgery.
- For those receiving bridging therapy with UFH or therapeutic-dose LMWH and undergoing non-high-bleeding-risk surgery, consider resuming heparin 24 hours after surgery.
- For those receiving bridging therapy with UFH or therapeutic-dose LMWH and undergoing high-bleeding-risk surgery, consider resuming heparin 48-72 hours after surgery.