Contemporary Perioperative Management of Direct Oral Anticoagulants

Adv Anesth. 2022 Dec;40(1):93-109. doi: 10.1016/j.aan.2022.06.002.

Abstract

Direct oral anticoagulants (DOACs) have rapidly emerged as popular alternatives to warfarin in the setting of nonvalvular atrial fibrillation, prevention and treatment of venous thromboembolism, and secondary prevention of arterial thrombosis. It is now estimated that more patients in the United States take DOACs than warfarin for approved indications. Studies to date have shown that these drugs are similarly efficacious with perhaps a lower bleeding risk than warfarin. The purpose of this review is to provide insight into the currently available DOACs and discuss the management and reversal strategies for patients in the perioperative period.

Keywords: Anticoagulant reversal; Bleeding; Direct oral anticoagulants; Novel oral anticoagulants; Transfusion.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants / therapeutic use
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / drug therapy
  • Humans
  • Venous Thromboembolism* / complications
  • Venous Thromboembolism* / drug therapy
  • Venous Thromboembolism* / prevention & control
  • Warfarin / therapeutic use

Substances

  • Warfarin
  • Anticoagulants