Emergency care of patients receiving non-vitamin K antagonist oral anticoagulants

Eikelboom, J.W. and Kozek-Langenecker, S. and Exadaktylos, A. and Batorova, A. and Boda, Z. and Christory, F. and Gornik, Ivan and Kėkštas, G. and Kher, A. and Komadina, R. and Koval, O. and Mitic, G. and Novikova, T. and Pazvanska, E. and Ratobilska, S. and Sütt, J. and Winder, A. and Zateyshchikov, D. (2018) Emergency care of patients receiving non-vitamin K antagonist oral anticoagulants. British Journal of Anaesthesia, 120 (4). pp. 645-656. ISSN 0007-0912

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Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban, edoxaban) have been introduced in several clinical indications. Although NOACs have a favourable benefit-risk profile and can be used without routine laboratory monitoring, they are associatedeas any anticoagulantewith a risk of bleeding. In addition, treatment may need to be interrupted in patients who need surgery or other procedures. The objective of this article, developed by a multidisciplinary panel of experts in thrombosis and haemostasis, is to provide an update on the management of NOAC-treated patients who experience a bleeding episode or require an urgent procedure. Recent advances in the development of targeted reversal agents are expected to help streamline the management of NOAC-treated patients in whom rapid reversal of anticoagulation is required.

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