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

Ashley N Budd; Miklos D Kertai; Moritz C Wyler von Ballmoos; Jacob Raphael; Kamrouz Ghadimi; Jerrold H Levy; Linda J Shore-Lesserson; Michael A Mazzeffi; Roman M Sniecinski; Kenichi A Tanaka; Daniel Bolliger; Mohamed Abdalla; Kelly G Ural; Patrick A Upchurch; Olga Rozental; Caroline B Hunter; Adam R Seibert; John C Klick; David Carroll; Katie Lobner; Nadia B Hensley

doi:10.1016/j.athoracsur.2026.01.005

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

Ann Thorac Surg. 2026 Apr;121(4):774-789. doi: 10.1016/j.athoracsur.2026.01.005. Epub 2026 Jan 29.

Authors

Ashley N Budd¹, Miklos D Kertai², Moritz C Wyler von Ballmoos³, Jacob Raphael⁴, Kamrouz Ghadimi⁵, Jerrold H Levy⁵, Linda J Shore-Lesserson⁶, Michael A Mazzeffi⁷, Roman M Sniecinski⁸, Kenichi A Tanaka⁹, Daniel Bolliger¹⁰, Mohamed Abdalla¹¹, Kelly G Ural¹², Patrick A Upchurch¹³, Olga Rozental¹⁴, Caroline B Hunter¹⁵, Adam R Seibert¹⁶, John C Klick¹⁷, David Carroll¹⁸, Katie Lobner¹⁹, Nadia B Hensley²⁰

Affiliations

¹ Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: ashley.budd@nm.org.
² Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
³ Department of Cardiovascular and Thoracic Surgery, Texas Health Fort Worth, Fort Worth, Texas.
⁴ Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia, Pennsylvania.
⁵ Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.
⁶ Department of Anesthesiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.
⁷ Department of Anesthesiology, University of Virginia Health, Charlottesville, Virginia.
⁸ Department of Anesthesiology, Emory Healthcare, Atlanta, Georgia.
⁹ Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
¹⁰ Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Badel, University of Basel, Basel, Switzerland.
¹¹ Department of Anesthesiology and Perioperative Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
¹² Department of Anesthesiology and Perioperative Medicine, The University of Queensland Medical School, Ochsner Clinical School, New Orleans, Louisiana.
¹³ Department of Anesthesiology, Health University of Utah, Salt Lake City, Utah.
¹⁴ Department of Anesthesiology, New York Presbyterian/ Weill Cornell Hospital, New York, New York.
¹⁵ Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
¹⁶ Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
¹⁷ Department of Anesthesiology, University of Vermont, Larner College of Medicine, Burlington, Vermont.
¹⁸ Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina.
¹⁹ Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
²⁰ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland.

PMID: 41609547
DOI: 10.1016/j.athoracsur.2026.01.005

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.

Publication types

Consensus Statement
Systematic Review
Practice Guideline

MeSH terms

Administration, Oral
Adult
Anticoagulants* / administration & dosage
Anticoagulants* / therapeutic use
Anticoagulation Bridge
Cardiac Surgical Procedures*
Factor Xa Inhibitors* / administration & dosage
Factor Xa Inhibitors* / therapeutic use
Humans
Societies, Medical

Substances

Anticoagulants
Factor Xa Inhibitors