Management of patients who are receiving warfarin or a new oral anticoagulant and require urgent or emergency surgery

Abstract

An increasing number of patients are receiving long‑term oral anticoagulant therapy and the availability of new oral anticoagulants (OACs), which are easier to use than warfarin, will further expand the population of anticoagulated patients. As a consequence, an increasing number of patients will need perioperative anticoagulant management because of elective or nonelective surgery or procedures. The perioperative management of such patients is pertinent to a broad spectrum of physicians, including anesthesiologists, internists, and surgeons. The objectives of this review are to provide a clinically‑focused background on the pharmacology of warfarin and the new OACs and to suggest perioperative anticoagulant management strategies. This review will focus on the perioperative management of warfarin and new OACs who require urgent or emergent surgery or who require rapid anticoagulant reversal because of ongoing bleeding or high bleeding risk.