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. 2022 Mar;122(3):329-335.
doi: 10.1055/a-1715-5960. Epub 2022 Feb 7.

Management of DOAC in Patients Undergoing Planned Surgery or Invasive Procedure: Italian Federation of Centers for the Diagnosis of Thrombotic Disorders and the Surveillance of the Antithrombotic Therapies (FCSA) Position Paper

Alessandro Squizzato  1 , Daniela Poli  2 , Doris Barcellona  3 , Antonio Ciampa  4 , Elvira Grandone  5   6 , Cesare Manotti  7 , Marco Moia  8 , Vincenzo Toschi  9 , Alberto Tosetto  10 , Sophie Testa  11 ; Scientific Reviewer Committee
Collaborators, Affiliations

Management of DOAC in Patients Undergoing Planned Surgery or Invasive Procedure: Italian Federation of Centers for the Diagnosis of Thrombotic Disorders and the Surveillance of the Antithrombotic Therapies (FCSA) Position Paper

Alessandro Squizzato et al. Thromb Haemost. 2022 Mar.

Abstract

Patients on anticoagulant treatment are constantly increasing, with an estimated prevalence in Italy of 2% of the total population. About a quarter of the anticoagulated patients require temporary cessation of direct oral anticoagulants (DOACs) or vitamin K antagonists for a planned intervention within 2 years from anticoagulation inception. Several clinical issues about DOAC interruption remain unanswered: many questions are tentatively addressed daily by thousands of physicians worldwide through an experience-based balancing of thrombotic and bleeding risks. Among possible valuable answers, the Italian Federation of Centers for the diagnosis of thrombotic disorders and the Surveillance of the Antithrombotic therapies (FCSA) proposes some experience-based suggestions and expert opinions. In particular, FCSA provides practical guidance on the following issues: (1) multiparametric assessment of thrombotic and bleeding risks based on patients' individual and surgical risk factor, (2) testing of prothrombin time, activated partial thromboplastin time, and DOAC plasma levels before surgery or invasive procedure, (3) use of heparin, (4) restarting of full-dose DOAC after high risk bleeding surgery, (5) practical nonpharmacological suggestions to manage patients perioperatively. Finally, FCSA suggests creating a multidisciplinary "anticoagulation team" with the aim to define the optimal perioperative management of anticoagulation.

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Conflict of interest statement

A.S.: Honoraria for lectures, manuscript writing, and/or participation on advisory board from Daiichi Sankyo, Bayer, Pfizer, Bristol-Myers Squibb, Sanofi, Werfen, Alexion, and Roche. D.P.: Honoraria for a webinar from Daiichi Sankyo. D.B.: Honoraria for lectures from Aspen and Werfen. A.C.: Honoraria for lectures from Bayer. E.G.: Honoraria for lectures from Sanofi and Italfarmaco, and for participation on advisory board from Roche, Sanofi Genzyme, and Novo Nordisk. C.M.: None. M.M.: Honoraria for lectures and manuscript writing from Daiichi-Sankyo. V.T.: Honoraria for lectures from Bayer and Novo Nordisk. A.T.: Honoraria for lectures from Werfen, Stago, and Roche; support for attending meetings from Novo Nordisk; honoraria for participation on advisory board from Bayer and Novo Nordisk. S.T.: Honoraria for lectures and for participation on advisory board from Werfen, Stago, Italfarmaco, Pfizer, Bristol-Myers Squibb, and Sanofi.

Figures

Fig. 1
Fig. 1
Practical nonpharmacological suggestions for patients at high bleeding risk in the periprocedural phase.
Fig. 2
Fig. 2
Multiparametric daily assessment for patients at high bleeding risk after surgery/invasive procedure.
Fig. 3
Fig. 3
Restarting DOAC after surgery/invasive procedure. DOAC, direct oral anticoagulant.
See this image and copyright information in PMC

References

    1. External reviewers . Steffel J, Collins R, Antz M. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021;23(10):1612–1676. - PMC - PubMed
    1. SSC Subcommittee on Perioperative and Critical Care Thrombosis and Haemostasis of the International Society on Thrombosis and Haemostasis . Spyropoulos A C, Brohi K, Caprini J. Scientific and Standardization Committee Communication: guidance document on the periprocedural management of patients on chronic oral anticoagulant therapy: recommendations for standardized reporting of procedural/surgical bleed risk and patient-specific thromboembolic risk. J Thromb Haemost. 2019;17(11):1966–1972. - PubMed
    1. BRIDGE Investigators . Douketis J D, Spyropoulos A C, Kaatz S. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373(09):823–833. - PMC - PubMed
    1. Douketis J D, Spyropoulos A C, Duncan J. Perioperative management of patients with atrial fibrillation receiving a direct oral anticoagulant. JAMA Intern Med. 2019;179(11):1469–1478. - PMC - PubMed
    1. Tafur A J, Clark N P, Spyropoulos A C. Predictors of bleeding in the perioperative anticoagulant use for surgery evaluation study. J Am Heart Assoc. 2020;9(19):e017316. - PMC - PubMed

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