Lucà Fabiana, Oliva Fabrizio, Giubilato Simona, Abrignani Maurizio Giuseppe, Rao Carmelo Massimiliano, Cornara Stefano, Caretta Giorgio, Di Fusco Stefania Angela, Ceravolo Roberto, Parrini Iris, Murrone Adriano, Geraci Giovanna, Riccio Carmine, Gelsomino Sandro, Colivicchi Furio, Grimaldi Massimo, Gulizia Michele Massimo
Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy.
Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy.
J Clin Med. 2024 May 24;13(11):3076. doi: 10.3390/jcm13113076.
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.
在过去十年中，直接口服抗凝剂（DOAC）的使用显著增加。由于无需定期进行实验室监测，且在疗效和安全性方面具有更有利的特性，这一趋势已超过维生素K拮抗剂（VKA）的处方量。然而，服用DOAC的患者需要进行介入或外科手术的情况非常常见，这需要仔细评估并采取具有挑战性的方法。因此，DOAC治疗患者的围手术期抗凝管理日益受到临床医生的关注。事实上，虽然一些外科手术需要暂时停用DOAC，但其他出血风险较低的手术可以在维持最低剂量或不间断DOAC策略的情况下进行。因此，除了手术考虑因素外，还必须对患者特征进行全面评估，包括年龄、中风易感性、既往出血并发症、同时服用的药物、肾和肝功能以及其他因素，以确定DOAC停药和重新开始使用的最佳时机。围手术期抗凝管理需要多学科方法，以确定如何应对这些情况。本叙述性综述旨在为医生提供一份DOAC围手术期管理的实用指南，解决最具争议的问题。
