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Perioperative Management of Direct Oral Anticoagulants (DOACs): A Systemic Review

机译：直接口服抗凝剂（DOAC）的围手术期管理：系统评价

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Direct oral anticoagulants (DOACs) are in wide use among patients requiring both short- and long-term anticoagulation, mainly due to their ease of use and the lack of monitoring requirements. With growing use of DOACs, it is imperative that physicians be able to manage patients on these medications, especially in the perioperative period. We aim to provide guidance on the management of DOACs in the perioperative period. In this review, we performed an extensive literature search summarizing the management of patients on direct-acting anticoagulants in the perioperative period. A total of four direct-acting oral anticoagulants were considered appropriate for inclusion in this review. The drugs were dabigatran etexilate mesylate (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). Management of patients on DOACs in the perioperative period involves an assessment of thromboembolic event risk while off anticoagulation compared to the relative risk of bleeding if such drug is continued. DOACs may not need to be discontinued in minor surgeries or procedures, and in major surgeries, they may be discontinued hours prior depending on drug pharmacokinetics and renal function of the patients.
机译：直接口服抗凝剂（DOAC）在需要短期和长期抗凝的患者中得到广泛使用，这主要是由于它们的易用性和缺乏监测要求。随着DOAC的使用越来越多，医生必须能够使用这些药物来管理患者，尤其是在围手术期。我们旨在为围手术期DOAC的管理提供指导。在这篇综述中，我们进行了广泛的文献检索，总结了围手术期使用直接作用抗凝剂的患者管理。共有四种直接作用的口服抗凝药被认为适合纳入本评价。药物是达比加群酯甲磺酸盐（Pradaxa），利伐沙班（Xarelto），阿哌沙班（Eliquis）和埃多沙班（Savaysa）。围手术期使用DOAC的患者管理涉及评估抗血栓栓塞事件发生风险，同时停用抗凝药物，如果继续使用此类药物，则相对于发生出血的相对风险进行评估。 DOAC可能不需要在小型手术或程序中停药，在大手术中，视患者的药物药代动力学和肾功能而定，可以在数小时前停药。

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