PDF(Pubmed)
Abstract：
A notable increase in direct oral anticoagulant (DOAC) use has been observed in the last decade. This trend has surpassed the prescription of vitamin K antagonists (VKAs) due to the absence of the need for regular laboratory monitoring and the more favorable characteristics in terms of efficacy and safety. However, it is very common that patients on DOACs need an interventional or surgical procedure, requiring a careful evaluation and a challenging approach. Therefore, perioperative anticoagulation management of patients on DOACs represents a growing concern for clinicians. Indeed, while several surgical interventions require temporary discontinuation of DOACs, other procedures that involve a lower risk of bleeding can be conducted, maintaining a minimal or uninterrupted DOAC strategy. Therefore, a comprehensive evaluation of patient characteristics, including age, susceptibility to stroke, previous bleeding complications, concurrent medications, renal and hepatic function, and other factors, in addition to surgical considerations, is mandatory to establish the optimal discontinuation and resumption timing of DOACs. A multidisciplinary approach is required for managing perioperative anticoagulation in order to establish how to face these circumstances. This narrative review aims to provide physicians with a practical guide for DOAC perioperative management, addressing the most controversial issues.
摘要：
在过去十年中观察到直接口服抗凝剂（DOAC）的使用显着增加。由于不需要定期实验室监测以及在疗效和安全性方面更有利的特征，这种趋势已经超过了维生素K拮抗剂（VKAs）的处方。然而,DOAC患者需要介入或外科手术是很常见的，需要仔细的评估和具有挑战性的方法。因此,DOAC患者的围手术期抗凝管理越来越受到临床医师的关注.的确,虽然一些外科手术需要暂时停止DOAC，可以进行其他出血风险较低的手术，保持最小或不间断的DOAC策略。因此,对患者特征的全面评估，包括年龄,对中风的易感性,既往出血并发症,同时用药，肾功能和肝功能，和其他因素，除了手术方面的考虑,必须建立DOAC的最佳停止和恢复时间。为了确定如何面对这些情况，需要多学科方法来管理围手术期抗凝治疗。这篇叙述性综述旨在为医生提供DOAC围手术期管理的实用指南，解决最有争议的问题。
