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

Jerrold H. Levy, Jean M. Connors, Marie E. Steiner, James Douketis, Alex C. Spyropoulos

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)562-568
Number of pages7
JournalResearch and Practice in Thrombosis and Haemostasis
Volume4
Issue number4
DOIs
StatePublished - May 1 2020

Bibliographical note

Funding Information:
The authors would like to thank Hanna Mourad-Agha of Fishawack Communications Ltd. for her help with editing and figure development; this assistance was investigator initiated and funded by CSL Behring at the request of the lead investigator. The authors would also like to thank Linda Shore Lesserson, MD, for her support with approving the survey.

Publisher Copyright:
© 2020 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals, Inc on behalf of International Society on Thrombosis and Haemostasis.

Keywords

  • anticoagulants
  • antidotes
  • apixaban
  • bleeding
  • dabigatran
  • fresh frozen plasma
  • prothrombin complex concentrates
  • rivaroxaban
  • warfarin

PubMed: MeSH publication types

  • Journal Article

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this