A clinical conundrum: to measure or not measure direct oral anticoagulants before a surgery or procedure?
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The management of patients who are receiving a direct oral anticoagulant (DOAC) and require a surgery or an invasive procedure is a common clinical problem, with 500,000–750,000 such patients being assessed annually in North America and Europe alone, and is pertinent to a wide array of clinicians that includes internists, surgeons and anaesthetists [1, 2]. The future scope of this problem is likely to increase as more patients receive a DOAC instead of a vitamin K antagonist (VKA) for the management of atrial fibrillation and venous thromboembolism especially in an ageing population, as elderly patients are most likely to require a surgery or invasive procedure .
The overall perioperative management of patients who are receiving an anticoagulant has shifted away from bridging with a low-molecular-weight heparin during anticoagulant interruption, given recent evidence that heparin bridging results in more bleeds without a reduction in thromboembolism whether patients are receiving...
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