Novel Oral Anticoagulants in Plastic Surgery

Publication date: Available online 2 March 2016
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): C.F. Munson, A.J. Reid
Novel oral anticoagulants (NOACs) have emerged as a good alternative to warfarin in the prevention of stroke for patients with atrial fibrillation. NOAC use is increasing rapidly therefore greater understanding of their use in the perioperative period is important for optimal care.Studies and reviews that reported on the use of NOACs were identified, with particular focus on the perioperative period. PubMed was searched for relevant articles published between January 2000 and August 2015.The inevitable rise in use of NOACs such as rivaroxaban (Xarelto^TM), apixaban (Eliquis^TM), edoxaban (Lixiana^TM) and dabigatran (Pradaxa^TM) may present a simplified approach to perioperative anticoagulant management due to fewer drug interactions, rapidity of onset of action, and relatively short half-lives. Coagulation status, however, cannot reliably be monitored and no antidotes are currently available. When planning for discontinuation of NOACs special consideration of renal function is required. Advice regarding the management of bleeding complications is provided for consideration in emergency surgery. In extreme circumstances haemodialysis may be considered for bleeding with use of dabigatran.NOACs will increasingly impact upon operative planning in plastic surgery. In order to reduce the incidence of complications associated with anticoagulation the management of NOACs in the perioperative period requires knowledge of time of last dose, renal function and the bleeding risk of the planned procedure. Consideration of these factors will allow appropriate interpretation of current guidelines.



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