Management of oral anticoagulants prior to emergency surgery or with major bleeding: A survey of perioperative practices in North America: Communication from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis.

dc.contributor.author

Levy, Jerrold H

dc.contributor.author

Connors, Jean M

dc.contributor.author

Steiner, Marie E

dc.contributor.author

Douketis, James

dc.contributor.author

Spyropoulos, Alex C

dc.date.accessioned

2020-07-01T14:23:57Z

dc.date.available

2020-07-01T14:23:57Z

dc.date.issued

2020-05

dc.date.updated

2020-07-01T14:23:56Z

dc.description.abstract

Background:There is limited information on real-world practice versus current clinical practice guidelines for oral anticoagulant reversal before emergency surgery. Objective:To identify current practice/knowledge gaps for oral anticoagulant reversal emergency surgery among anesthesiologists. Methods:A 22-question survey covering aspects of clinical practice relating to oral anticoagulant reversal was sent to American Society of Anesthesiology members with weekly reminders during data collection from October to December 2018. Results:Responses were received from 2315 anesthesiologists of which 86% of respondents were United States based. Emergency surgery was defined as occurring within 4 hours of the decision to operate by 60% of respondents. Fresh frozen plasma (FFP) was used by 75% of respondents for vitamin K antagonist (VKA) reversal and by 54% for direct oral anticoagulant (DOAC) reversal in emergency surgery and 67% in major operative bleeding. Only 32% of institutions had emergency anticoagulant reversal protocols, and 54% of respondents selected an international normalized ration (INR) ratio goal for VKA reversal of ≤1.5. Only 13% initially consulted or coordinated management with hematologists, and the final decision regarding coagulation management was made by the respondent in 26% of cases. A coordinated approach with hematologists and cardiologists was reported by 64%, and over half (51%) required approval for prothrombin complex concentrate administration for emergency procedures. Conclusions:Despite recommendations to the contrary, FFP is extensively used for emergency VKA and DOAC reversal. There is a clear need for institutions to develop guideline-informed recommendations/management algorithms based on input from medical professionals routinely involved in management of these patients.

dc.identifier

RTH212320

dc.identifier.issn

2475-0379

dc.identifier.issn

2475-0379

dc.identifier.uri

https://hdl.handle.net/10161/21111

dc.language

eng

dc.publisher

Wiley

dc.relation.ispartof

Research and practice in thrombosis and haemostasis

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10.1002/rth2.12320

dc.subject

anticoagulants

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antidotes

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apixaban

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bleeding

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dabigatran

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fresh frozen plasma

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prothrombin complex concentrates

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rivaroxaban

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warfarin

dc.title

Management of oral anticoagulants prior to emergency surgery or with major bleeding: A survey of perioperative practices in North America: Communication from the Scientific and Standardization Committees on Perioperative and Critical Care Haemostasis and Thrombosis of the International Society on Thrombosis and Haemostasis.

dc.type

Journal article

pubs.begin-page

562

pubs.end-page

568

pubs.issue

4

pubs.organisational-group

School of Medicine

pubs.organisational-group

Surgery, Cardiovascular and Thoracic Surgery

pubs.organisational-group

Anesthesiology, Cardiothoracic

pubs.organisational-group

Duke

pubs.organisational-group

Surgery

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Anesthesiology

pubs.publication-status

Published

pubs.volume

4

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