Friday, June 28, 2013

Q; What are the guidelines on new oral anticoagulants (NOACs) on holding before surgical procedures?


Warfarin remained the lone oral anti-coagulant for almost 40 years. The new anticoagulants (NOACs) are: 

1. Dabigatran - a direct thrombin inhibitor 
2. Rivaroxaban - a direct factor Xa inhibitor 
3. Apixaban - a direct factor Xa inhibitor 

They have relatively short half life and dissipate rapidly within 12-24 hours after a dose. 

In patients with normal renal function, the NOACs should be held for ≥24 hours before an elective surgical procedure associated with a minor bleeding risk, and for ≥48 hours before surgical procedures associated with a major bleeding risk.

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