Perioperative management of patients on NOACs

• Published in: Medizinische Klinik, Intensivmedizin und Notfallmedizin Vol. 112; no. 2; pp. 125 - 128
• Main Authors: Kelm, C, Engels, K
• Format: Journal Article
• Language: German
• Published: Germany 01-03-2017
• Subjects: Administration, Oral; Aged, 80 and over; Antibodies, Monoclonal, Humanized - adverse effects; Antibodies, Monoclonal, Humanized - therapeutic use; Anticoagulants - adverse effects; Anticoagulants - pharmacokinetics; Anticoagulants - therapeutic use; Blood Coagulation - drug effects; Blood Loss, Surgical - prevention & control; Fatal Outcome; Female; Hemangioma - blood; Hemangioma - complications; Hemangioma - surgery; Hemorrhage - blood; Hemorrhage - chemically induced; Humans; Liver Neoplasms - blood; Liver Neoplasms - complications; Liver Neoplasms - surgery; Perioperative Care - methods; Risk Factors; Surgical Procedures, Operative; Thromboembolism - blood; Thromboembolism - prevention & control; Vitamin K - antagonists & inhibitors; Emergencies; Thromboembolism; Hemorrhage; Surgery; Prophylaxis
• ISSN: 2193-6226
• DOI: 10.1007/s00063-016-0244-y

Regarding thromboembolic events, non-vitamin K antagonists, so-called new oral anticoagulative agents (NOACs), have widely enlarged prophylaxis and therapy. In contrast to vitamin K antagonists they can be administered in a definite dose and do not need any regular control of coagulation parameters. Thus being simple in handling, these drugs have become enormously attractive for both patient and physician.In spite of all their advantages NOACs have to be considered carefully. They have a significant disadvantage: the plasma concentration is not detectable by a simple blood test, nor is there any antidote available. As a consequence the bleeding risk remains unknown.In this review we focus on two different settings in routine surgical work: the preoperative management of patients undergoing elective surgery differs significantly from that needed in urgent surgery.