Sunkara Tagore, Ofori Emmanuel, Zarubin Vadim, Caughey Megan E, Gaduputi Vinaya, Reddy Madhavi
Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA.
Division of Hematology and Oncology, The Brooklyn Hospital Center, Brooklyn, NY, USA.
Health Serv Insights. 2016 Dec 13;9(Suppl 1):25-36. doi: 10.4137/HSI.S40701. eCollection 2016.
Direct oral anticoagulants (DOACs) are in wide use among patients requiring both short- and long-term anticoagulation, mainly due to their ease of use and the lack of monitoring requirements. With growing use of DOACs, it is imperative that physicians be able to manage patients on these medications, especially in the perioperative period. We aim to provide guidance on the management of DOACs in the perioperative period. In this review, we performed an extensive literature search summarizing the management of patients on direct-acting anticoagulants in the perioperative period. A total of four direct-acting oral anticoagulants were considered appropriate for inclusion in this review. The drugs were dabigatran etexilate mesylate (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). Management of patients on DOACs in the perioperative period involves an assessment of thromboembolic event risk while off anticoagulation compared to the relative risk of bleeding if such drug is continued. DOACs may not need to be discontinued in minor surgeries or procedures, and in major surgeries, they may be discontinued hours prior depending on drug pharmacokinetics and renal function of the patients.
直接口服抗凝剂（DOACs）在需要短期和长期抗凝治疗的患者中广泛使用，主要是因为其使用方便且无需监测。随着DOACs的使用日益增加，医生必须能够管理使用这些药物的患者，尤其是在围手术期。我们旨在提供围手术期DOACs管理的指导。在本综述中，我们进行了广泛的文献检索，总结了围手术期使用直接作用抗凝剂患者的管理情况。共有四种直接作用口服抗凝剂被认为适合纳入本综述。这些药物分别是达比加群酯甲磺酸盐（Pradaxa）、利伐沙班（Xarelto）、阿哌沙班（Eliquis）和依度沙班（Savaysa）。围手术期使用DOACs的患者管理涉及评估停用抗凝剂时的血栓栓塞事件风险与继续使用此类药物时的相对出血风险。在小型手术或操作中，DOACs可能无需停用，而在大型手术中，根据药物的药代动力学和患者的肾功能，可能需要在术前数小时停用。
