Management of Direct Oral Anticoagulants in Adult Patients Undergoing Cardiac Surgery: A Joint Consensus Statement by the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons

Anesth Analg. 2026 Apr 1;142(4):668-681. doi: 10.1213/ANE.0000000000007868. Epub 2026 Jan 29.

Abstract

The Society of Cardiovascular Anesthesiologists (SCA) along with the Society of Thoracic Surgeons (STS) sought to improve the care of adult patients undergoing cardiac surgery who are taking direct oral anticoagulants (DOACs), such as factor Xa and direct thrombin inhibitors. To fulfill this, a systematic review of the literature on cessation of DOACs before cardiac surgery, options for monitoring DOACs, the need for bridging, reversal agents, and resuming the medications after surgery was performed. Additionally, an expert consensus around the management of these patients was completed. Summary statements were created using evidence and expert consensus to guide care of patients in each of these domains, with the ultimate goal to enhance patient safety and outcomes.

Trial registration: ClinicalTrials.gov NCT04045665.

Publication types

  • Consensus Statement
  • Systematic Review
  • Practice Guideline

MeSH terms

  • Administration, Oral
  • Adult
  • Anesthesiologists* / standards
  • Anticoagulants* / administration & dosage
  • Anticoagulants* / adverse effects
  • Antithrombins* / administration & dosage
  • Antithrombins* / adverse effects
  • Cardiac Surgical Procedures* / adverse effects
  • Cardiac Surgical Procedures* / standards
  • Consensus
  • Factor Xa Inhibitors* / administration & dosage
  • Factor Xa Inhibitors* / adverse effects
  • Humans
  • Risk Factors
  • Societies, Medical* / standards
  • Thoracic Surgery* / standards
  • Treatment Outcome

Substances

  • Antithrombins
  • Factor Xa Inhibitors
  • Anticoagulants

Associated data

  • ClinicalTrials.gov/NCT04045665