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J Mal Vasc. 2015 May;40(3):173-81. doi: 10.1016/j.jmv.2015.02.004. Epub 2015 Mar 14.

[Management of direct oral anticoagulants for invasive procedures].

[Article in French]

Author information

1
Service d'anesthésie-réanimation, fondation ophtalmologique Adolphe-de-Rothschild, 25, rue Manin, 75019 Paris, France; Inserm UMR-S1140, université Paris-Descartes, Sorbonne Paris-Cité, 75006 Paris, France. Electronic address: agodier@fo-rothschild.fr.
2
Inserm UMR-S1140, université Paris-Descartes, Sorbonne Paris-Cité, 75006 Paris, France; Laboratoire d'hématologie, groupe hospitalier Cochin-Hôtel-Dieu, AP-HP, 75014 Paris, France.
3
Service d'anesthésie-réanimation, groupe hospitalier Cochin-Hôtel-Dieu, AP-HP, 75014 Paris, France.
4
Pôle d'anesthésie-réanimation, CHU de Grenoble, 38000 Grenoble, France.

Abstract

Three new Direct Oral Anticoagulants (DOACs), rivaroxaban, apixaban and dabigatran etexilate are available on the French market. Management of DOAC-induced bleeding risk remains challenging. For elective procedures with high hemorrhagic risk, a last DOAC intake five days before procedure ensures complete elimination in all patients. Heparin bridging therapy should be proposed only to patients at high thrombotic risk. For elective procedures with low hemorrhagic risk, the DOAC intake of the night before procedure should be omitted. For urgent procedures with high bleeding risk, DOAC plasmatic concentration can be helpful: concentration lower than 30 ng/mL should enable performing the procedure; a high concentration is associated with a higher bleeding risk, especially if higher than 400 ng/mL. In case of massive bleeding, no antidote is approved yet; activated prothrombin concentrates or non-activated 4-factors prothrombin concentrates could be considered.

KEYWORDS:

Antagonisation; Anticoagulant; Antidote; Bleeding; Chirurgie; Hémorragie; Reversal; Surgery

PMID:
25778841
DOI:
10.1016/j.jmv.2015.02.004
[Indexed for MEDLINE]

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