Internal and Emergency Medicine

, Volume 13, Issue 7, pp 997–999 | Cite as

A clinical conundrum: to measure or not measure direct oral anticoagulants before a surgery or procedure?

  • James D. DouketisEmail author
  • Mansoor Radwi

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 [3].

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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Conflict of interest

The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Società Italiana di Medicina Interna 2018

Authors and Affiliations

  1. 1.Department of MedicineSt. Joseph’s Healthcare Hamilton and McMaster UniversityHamiltonCanada
  2. 2.Department of Hematology, Faculty of MedicineUniversity of JeddahJeddahSaudi Arabia

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