Peri-Procedural Management of Oral Anticoagulants in the DOAC Era

Barnes, Geoffrey D.; Mouland, Erin

doi:10.1016/j.pcad.2018.03.002

Cited by 31 publications

(39 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…DOAC Stop has been assessed for DOAC neutralization in several studies, but mostly related to assessment of thrombophilia, 18,19,[26][27][28][29][30][31] and included in only a few studies related to factor assays. 30,32 To our knowledge, no study has previously assessed the effect of andexanet alfa on factor levels and DOAC interference.…”

Section: Discussionmentioning

confidence: 99%

Reducing the effect of DOAC interference in laboratory testing for factor VIII and factor IX: A comparative study using DOAC Stop and andexanet alfa to neutralize rivaroxaban effects

et al. 2020

View full text Add to dashboard Cite

Introduction Investigation of factors (F) VIII and IX is common, with testing important for diagnosis or exclusion of haemophilia A or B, associated acquired conditions and factor inhibitors. Rivaroxaban, a common direct anti‐Xa agent, causes significant interference in clotting assays, including substantial false reduction of factor levels. Aim To assess whether rivaroxaban‐induced interference of FVIII and FIX testing could be neutralized. Materials and methods An international, cross‐laboratory exercise for FVIII (n = 84) and FIX (n = 74), using four samples: (A) pool of normal plasma; (B) pool spiked with rivaroxaban (200 ng/mL); (C) rivaroxaban sample subsequently treated with ‘DOAC Stop’ and; (D) rivaroxaban sample treated with andexanet alfa (200 μg/mL). Testing performed blind to sample type. Results All laboratories reported normal FIX and 94% reported normal FVIII in the pool sample. Instead, 55% and 95%, respectively, reported abnormal FIX and FVIII levels for the rivaroxaban sample. DOAC Stop treatment evidenced a correction in most laboratories (100% reported normal FIX and 86% normal FVIII). Andexanet alfa provided intermediate results, with many laboratories still reporting abnormal results (59% for FVIII, 18% for FIX). We also identified reagent‐specific issues. Conclusions As expected, rivaroxaban caused false low values of FVIII and FIX. This might lead to increased testing to identify the cause of low factor levels and potentially lead to false identification of (mild) haemophilia A or B if unrecognized by clinicians/laboratories. DOAC Stop effectively neutralized the rivaroxaban effect, but andexanet alfa less so, with reagent‐related effects evident, and thus, false low values sometimes persisted.

show abstract

Section: Discussionmentioning

confidence: 99%

Reducing the effect of DOAC interference in laboratory testing for factor VIII and factor IX: A comparative study using DOAC Stop and andexanet alfa to neutralize rivaroxaban effects

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Furthermore, coagulation monitoring might be useful in certain populations, considering the elevated interindividual variability of DOAC plasma concentrations ( Doherty et al, 2017 ). The periprocedural management of DOACs has been extensively reviewed in Barnes and Mouland (2018 ).…”

Section: Bridging In Procedural Management and Reversal Agentsmentioning

confidence: 99%

Direct Oral Anticoagulants: From Randomized Clinical Trials to Real-World Clinical Practice

et al. 2021

View full text Add to dashboard Cite

Direct oral anticoagulants (DOACs) are a more manageable alternative than vitamin K antagonists (VKAs) to prevent stroke in patients with nonvalvular atrial fibrillation and to prevent and treat venous thromboembolism. Despite their widespread use in clinical practice, there are still some unresolved issues on optimizing their use in particular clinical settings. Herein, we reviewed the current clinical evidence on uses of DOACs from pharmacology and clinical indications to safety and practical issues such as drugs and food interactions. Dabigatran is the DOAC most affected by interactions with drugs and food, although all DOACs demonstrate a favorable pharmacokinetic profile. Management issues associated with perioperative procedures, bleeding treatment, and special populations (pregnancy, renal and hepatic impairment, elderly, and oncologic patients) have been discussed. Literature evidence shows that DOACs are at least as effective as VKAs, with a favorable safety profile; data are particularly encouraging in using low doses of edoxaban in elderly patients, and edoxaban and rivaroxaban in the treatment of venous thromboembolism in oncologic patients. In the next year, DOAC clinical indications are likely to be further extended.

show abstract

“…When is it convenient to resume anticoagulation in the post-operative period? 22,23 These questions could be addressed in PTERRTs, in close interrelation also with pharmaceutical chemists with experience in anti-thrombotic agents, who should also be viewed as PTERRTs proactive members.…”

Section: Potential Role Of Pterrts In the Perioperative Periodmentioning

confidence: 99%

Participation of pulmonary embolism response teams during the perioperative period

Porres‐Aguilar¹,

Anaya‐Ayala²,

Grimaldo-Gómez³

et al. 2020

ACME

View full text Add to dashboard Cite

Acute pulmonary embolism represents a frequent cause of cardiovascular morbidity and mortality, only exceeded by acute coronary syndromes and cerebrovascular disease. The start-up and implementation of a designated pulmonary embolism response team (PERT) are necessary to improve prognosis and minimize long-term sequelae in the subgroup of patients with significant pulmonary embolism. Herein, we describe and discuss an overview of the current and potential role of PERT, with a focus on the perioperative period.

show abstract

Peri-Procedural Management of Oral Anticoagulants in the DOAC Era

Cited by 31 publications

References 27 publications

Reducing the effect of DOAC interference in laboratory testing for factor VIII and factor IX: A comparative study using DOAC Stop and andexanet alfa to neutralize rivaroxaban effects

Reducing the effect of DOAC interference in laboratory testing for factor VIII and factor IX: A comparative study using DOAC Stop and andexanet alfa to neutralize rivaroxaban effects

Direct Oral Anticoagulants: From Randomized Clinical Trials to Real-World Clinical Practice

Participation of pulmonary embolism response teams during the perioperative period

Contact Info

Product

Resources

About