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Andexanet Alfa Use in Cardiac Surgical Patients: A Xa Inhibitor and Heparin Reversal Agent
THE NONVITAMIN K direct oral anticoagulants (DOACs) currently are approved for clinical use for the prevention of cerebrovascular embolic stroke in patients with nonvalvular atrial fibrillation, and as antithrombotic therapy and prophylaxis.1 As a result, clinicians should be aware of perioperative management strategies for both elective and emergency surgery in patients receiving these agents. Currently, specific reversal agents, also referred to as antidotes, are available for dabigatran (idarucizumab) and Xa inhibitors (andexanet alfa).
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 13, 2020 Category: Anesthesiology Authors: Jerrold H. Levy, Jean M. Connors Tags: Editorial Source Type: research

Idarucizumab for dabigatran reversal in daily clinical practice: A case series
CONCLUSION Our first experiences with idarucizumab use in daily-care settings support a rapid and efficient decrease in the anticoagulant effect of dabigatran in emergency situations. Late re-occurrence of dabigatran effect was noted in a subset of patients with severe renal failure.
Source: European Journal of Anaesthesiology - September 12, 2020 Category: Anesthesiology Tags: Coagulation Source Type: research

Four-factor Prothrombin Complex Concentrate for the Management of Patients Receiving Direct Oral Activated Factor X Inhibitors
Direct oral anticoagulants (DOACs) have been approved for the prevention of stroke and systemic embolism in atrial fibrillation, treatment and secondary prevention of venous thromboembolism (VTE), and thromboprophylaxis after major orthopedic surgery. DOACs achieve anticoagulation by inhibiting specific coagulation factors; apixaban, betrixaban, edoxaban, and rivaroxaban inhibit activated factor X, whereas dabigatran inhibits thrombin (factor IIa). In contrast to vitamin K antagonists such as warfarin, DOACs have more predictable pharmacokinetics and pharmacodynamics and fewer interactions with other medications and food, ...
Source: Anesthesiology - October 15, 2019 Category: Anesthesiology Source Type: research

Managing the perioperative patient on direct oral anticoagulants
ConclusionPerioperative management of anticoagulation due to DOACs is a growing concern as the number of patients prescribed these medications increases each year. These patients can be safely optimized for urgent or emergent surgery by giving appropriate consideration to timing, monitoring, and reversal agents.
Source: Canadian Journal of Anesthesia - May 13, 2017 Category: Anesthesiology Source Type: research

Managing the perioperative patient on direct oral anticoagulants.
CONCLUSION: Perioperative management of anticoagulation due to DOACs is a growing concern as the number of patients prescribed these medications increases each year. These patients can be safely optimized for urgent or emergent surgery by giving appropriate consideration to timing, monitoring, and reversal agents. PMID: 28429198 [PubMed - as supplied by publisher]
Source: Canadian Journal of Anaesthesia - April 20, 2017 Category: Anesthesiology Authors: Leitch J, van Vlymen J Tags: Can J Anaesth Source Type: research

A Case of Fatal Bleeding Following Emergency Surgery on an Ascending Aorta Intramural Hematoma in a Patient Taking Dabigatran
INTRAMURAL HEMATOMA (IMH) is an acute aortic syndrome. More frequently—in 60% to 70% of cases—IMH involves the descending aorta (type B), whereas the involvement of the ascending aorta and aortic arch accounts for 30% and 10% of the cases, respectively. Hospital mortality of type-A IMH is similar to type-A aortic dissection. Cardiocirculatory shock secondary to cardiac tamponade, together with stroke, coma, and impaired coronary perfusion, are important predictive factors of postoperative mortality.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 13, 2016 Category: Anesthesiology Authors: Giulia Beatrice Crapelli, Paolo Bianchi, Giuseppe Isgrò, Andrea Biondi, Carlo de Vincentiis, Marco Ranucci Tags: Case Report Source Type: research

The Effect of Cardiopulmonary Bypass on Dabigatran Levels
DABIGATRAN IS a novel anticoagulant that is licensed for use for the prevention of stroke in the presence of atrial fibrillation. Its use has expanded rapidly in New Zealand, primarily due to there being no requirement for routine monitoring of its effect, as there is for warfarin. There are case reports in the literature describing management of patients coming for urgent cardiac surgery, which revolve mainly around the use of dialysis and massive transfusion of clotting factors to manage the bleeding associated with surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 31, 2015 Category: Anesthesiology Authors: Kelly Byrne Tags: CASE REPORT Source Type: research

Perioperative venous thromboembolic disease and the emerging role of the novel oral anticoagulants: An analysis of the implications for perioperative management.
Abstract Venous thromboembolism includes 2 inter-related conditions: Deep venous thrombosis and pulmonary embolism. Heparin and low-molecular-weight heparin followed by oral anticoagulation with vitamin K agonists is the first line and current accepted standard therapy with good efficacy. However, this therapeutic strategy has many limitations including the significant risk of bleeding and drug, food and disease interactions that require frequent monitoring. Dabigatran, rivaroxaban, apixaban, and edoxaban are the novel oral anticoagulants that are available for use in stroke prevention in atrial fibrillation and f...
Source: Annals of Cardiac Anaesthesia - October 1, 2015 Category: Anesthesiology Authors: Mookadam M, Shamoun FE, Ramakrishna H, Obeid H, Rife RL, Mookadam F Tags: Ann Card Anaesth Source Type: research

Management of Direct Oral Anticoagulants in the Perioperative Setting
AN INCREASING NUMBER of patients undergoing surgical procedures are treated chronically by oral anticoagulants (OAC). Vitamin K antagonists (VKAs) have been standard practice in chronic anticoagulant therapy for decades. Despite a proved efficacy, they have several disadvantages. Over the past 5 years, direct oral anticoagulants (DOAs) such as dabigatran, rivaroxaban, apixaban, and edoxaban have been approved for several indications for long-term anticoagulation. Consequently, with the aging population and the extension of the indication of anticoagulation for stroke prevention in nonvalvular atrial fibrillation (AF), ther...
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 24, 2015 Category: Anesthesiology Authors: Olivier Untereiner, Pierre-François Seince, Vladimir Chterev, Isabelle Leblanc, Clarisse Berroëta, Patrick Bourel, Ivan Philip Tags: Review ArticlesGiovanni Landoni, MDSection Editors? > Source Type: research

Case 4–2015
ATRIAL FIBRILLATION (AF) is the most common cardiac arrhythmia in the world and is estimated to affect more than 3 million people in the United States, with a projected increase to more than 5 million people in the US by the year 2050.1 AF is an independent risk factor for stroke and is associated with a four- to five-fold increased risk of embolic stroke compared with those individuals without AF. Oral anticoagulation therapy with warfarin or other agents (dabigatran, apixaban) significantly reduces the risk of stroke in this population; however, anticoagulation carries inherent risks.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 18, 2015 Category: Anesthesiology Authors: Megan J. Lanigan, Mark A. Chaney, Sandeep Nathan, Atman P. Shah, Andrew J. Feider Tags: Case Conference Source Type: research

Hemorrhagic stroke and new oral anticoagulants.
Abstract The recent release of new oral anticoagulants (NOAC) raises the question of the management of intracranial hemorrhage occurring during treatment with these molecules. Dabigatran, rivaroxaban and apixaban have different pharmacological characteristics that physicians need to know to adjust their prescription to each patient. Studies of efficacy and safety prior to the marketing of these molecules showed a decreased risk of intracranial hemorrhage compared with vitamin K antagonists. However, no reliable data are available regarding the prognosis of these hemorrhages occurring during NOAC treatment. In addi...
Source: Annales Francaises d'Anesthesie et de Reanimation - October 1, 2014 Category: Anesthesiology Authors: Derlon V, Corbonnois G, Martin M, Toussaint-Hacquard M, Audibert G Tags: Ann Fr Anesth Reanim Source Type: research

Patient with acute renal injury presenting dabigatran overdose: Hemodialysis for surgery.
We report a case of an 80-year-old man presenting hemorrhage with dabigatran overdose caused by obstructive acute renal failure. Before nephrostomy, several hemodialysis sessions were necessary to remove dabigatran probably because of its large volume of distribution. PMID: 24378048 [PubMed - as supplied by publisher]
Source: Annales Francaises d'Anesthesie et de Reanimation - December 27, 2013 Category: Anesthesiology Authors: Bachellerie B, Ruiz S, Conil JM, Crognier L, Seguin T, Georges B, Fourcade O Tags: Ann Fr Anesth Reanim Source Type: research

Managing New Oral Anticoagulants in the Perioperative and Intensive Care Unit Setting
Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with an...
Source: Anesthesiology - April 23, 2013 Category: Anesthesiology Tags: Education: Review Article Source Type: research