Managing DOACs Perioperatively

Drawing from guidelines and a general review of the literature, experts offer management recommendations for direct-acting oral anticoagulants before and after invasive interventions.

With the advent of direct-acting oral anticoagulants (DOACs) — apixaban, dabigatran, edoxaban, and rivaroxaban — many patients who undergo elective or nonelective surgery now require perioperative anticoagulation management of these drugs. In this review, two of the authors of the recent CHEST guidelines for perioperative management of antithrombotic therapy (NEJM JW Gen Med Dec 15 2022 and Chest 2022; 162:1127) summarize the current supporting evidence and offer guidance related to managing this increasingly common medication class in patients undergoing surgery (JAMA 2024 Aug 12; [e-pub]). Key points are as follows:

Elective surgeries or procedures with minimal bleeding risk

Examples: cardiac device implantation, coronary angiography with r…

Author

Daniel D. Dressler, MD, MSc, MHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Daniel D. Dressler, MD, MSc, MHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Managing DOACs Perioperatively

Topics

Elective surgeries or procedures with minimal bleeding risk

Author