Guidelines for perioperative management and bleeding in patients using direct oral anticoagulants (NOACs)

Abstract

Novel direct oral anticoagulants (NOACs) have emerged as a new option for patients requiring anticoagulation for both prophylactic and therapeutic thromboembolic events. Numerous advantages of NOACs are in relation to conventional anticoagulants, which include the use of a target therapy, without the need for control with laboratory tests and without interference with food. They have also been shown to be as or more effective compared to conventional anticoagulants. However, some patients may experience bleeding complications, especially in special sub populations such as the elderly, patients with renal and / or hepatic impairment, and with the use of certain medications. This bleeding, in most cases, is handled with supportive measures. However, some patients may develop bleeding into some vital organ and become urgency in diagnosis and approach. We suggest, in a simplified way, a management orientation in patients with bleeding in the use of NOACs, both spontaneously and in the management of patients using NOACs in the perioperative period, in order to avoid bleeding.