Department of Medicine, McMaster University, Hamilton, ON, Canada.
Intern Emerg Med. 2013 Sep;8(6):477-84. doi: 10.1007/s11739-013-0963-5. Epub 2013 Jun 27.
The use of novel oral anticoagulants (NOACs) is increasing since these drugs are at least as efficacious and safe as vitamin K antagonists (VKAs) for the management of patients with non-valvular atrial fibrillation and venous thromboembolism. Compared with VKAs, NOACs have a faster onset and offset of action, a predictable and consistent pharmacokinetic profile, fewer drug interactions, and ease of use since anticoagulant monitoring is not required. Current perioperative management will be affected by these characteristics, with the potential to obviate the need for heparin bridging. This review aims to summarize the current evidence of perioperative thromboembolic and bleeding risk during anticoagulant interruption, which is derived predominantly from patients receiving VKA therapy, and early studies involving NOACs which mainly focus on patients who are receiving dabigatran. The role of heparin bridging is discussed. We also provide a practical approach for the perioperative management of patients who are receiving NOAC therapy.
新型口服抗凝剂（NOACs）的使用正在增加，因为这些药物在管理非瓣膜性心房颤动和静脉血栓栓塞症患者方面与维生素 K 拮抗剂（VKAs）一样有效和安全。与 VKAs 相比，NOACs 具有更快的作用开始和结束时间、可预测和一致的药代动力学特征、更少的药物相互作用以及易于使用，因为不需要进行抗凝监测。目前的围手术期管理将受到这些特征的影响，有可能避免肝素桥接的需要。本综述旨在总结抗凝中断期间围手术期血栓栓塞和出血风险的现有证据，这些证据主要来源于接受 VKA 治疗的患者，以及早期涉及主要关注接受达比加群治疗的患者的 NOAC 研究。肝素桥接的作用也进行了讨论。我们还为接受 NOAC 治疗的患者的围手术期管理提供了一种实用方法。
