What is the role of novel oral anticoagulants (NOACs) in perioperative anticoagulation management?

Updated: May 08, 2018
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: William A Schwer, MD  more...
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Lai addresses perioperative management of patients on new oral anticoagulants. Novel oral anticoagulants (NOACs) offer an alternative to warfarin for preventing stroke in patients with atrial fibrillation. Management of NOACs in elective and emergency conditions requires knowledge of time of last intake of drug, current renal function, and the planned procedure in order to assess the overall risk of bleeding. [15]

The first of several NOAC reversal agents, idarucizumab (Praxbind), was approved by the FDA in October 2015. Idarucizumab is a monoclonal antibody that binds specifically to dabigatran (it does not affect other NOACs). It is approved for patients treated with dabigatran when reversal of the anticoagulant effects are needed for emergency surgery or urgent procedures, or in the event of life-threatening or uncontrolled bleeding.

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