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Perioperative Management of DOACs in Vascular Surgery: A Practical Approach

Author(s):

George Kouvelos*, Miltiadis Matsagkas, Nikolaos Rousas, Petroula Nana, Konstantinos Mpatzalexis, Konstantinos Stamoulis, Athanasios Giannoukas and Eleni Arnaoutoglou   Pages 1 - 7 ( 7 )

Abstract:


Background: Approximately 10–15% of patients on DOACs will have to interrupt their anticoagulant before an invasive procedure every year. The perioperative management and monitoring of DOACs has proved to be challenging, as differences in patients’ status and in the invasiveness of each procedure develop different situations that need a tailored to each patient’s needs therapeutic approach.

Methods: This review aims to summarize current evidence on the perioperative management of DOACs in patients undergoing a vascular surgical procedure focusing with a practical approach on three key clinical questions: (i) can we stop DOAC therapy before the vascular procedure? (ii) is bridging therapy necessary? and (iii) which is the best perioperative strategy for interruption and resumption of the anticoagulant therapy?

Results: No specific data exist for the perioperative management of vascular surgery patients on DOACs, as most studies include low number of them. Therapeutic strategy on how to handle DOACs perioperatively must be based on their half-life, the bleeding risk of the invasive procedures, and on the thromboembolic risk of the patient. Renal function plays a crucial role in such situations, increasing thromboembolic and bleeding risk. In general, DOACs should be stopped 2 days for high bleed risk, 1 day for low risk and be resumed 48-72 hrs after high risk, 24 hrs after low risk procedure. Bridging is almost never needed.

Conclusion: Further perioperative research studies on patients undergoing vascular surgery are needed to confirm whether currently accepted therapeutic perioperative strategy is appropriate for these patients.

Keywords:

vascular surgery, anticoagulants, perioperative period, invasive procedures, DOAC

Affiliation:

Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa



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