The Overview and update of anticoagulant management in urgent and elective procedures: Update on management of oral anticoagulants

Abstract

In recent years, with the introduction of direct oral anticoagulants, anticoagulant therapy has once again taken a leap. With advantages of not requiring strict monitoring like Warfarin, with fewer interactions, predictable pharmacokinetics, but with limitations in the face of kidney diseases and prosthetic valves.
Anticoagulants are used in pathologies such as atrial fibrillation, acute myocardial infarction, thromboembolism, prosthetic valves, neoplasms, and thrombophilia; It is essential for health professionals to know its characteristics. Especially during pre-surgical preparation, both in urgent and elective procedures.
In recent years, innovations in anticoagulation have consistently updated the recommendations and guidelines, that the bridging of anticoagulants such as Warfarin with heparins are only reserved for certain cases, in accordance with clinical judgment and interdisciplinary management of other medical specialties. Considering the clinical history, comorbidities, and the surgical risk of the procedure, with the aim of having a balance between the risks of thromboembolism and bleeding.
The new oral direct anticoagulants do not require anticoagulant bridging, easing more surgical preparations. In acute procedures, the goal is to reverse anticoagulation. At the same time, anticoagulant antidotes have advanced, with Idarucizumab and Andexanet, for the reversal of direct oral anticoagulants.
Ciraparantag has not yet been approved, with the possibility of being a universal antidote for all anticoagulant drugs. With these advances, certain practices have become the second option as treatment, such as the use of fresh frozen plasma, due to the risks and disadvantages compared to the new procedures.