Direct Oral Anticoagulants: How Do These Drugs Work, How to Monitor, and What Is Their Role in Orthopaedic Surgery.
John C HagedornSean G YatesJie ChenBrian D AdkinsPublished in: The Journal of the American Academy of Orthopaedic Surgeons (2023)
Postoperative venous thromboembolism is a major adverse event associated with orthopaedic surgery. With the addition of perioperative anticoagulation and antiplatelet therapy, the rates of symptomatic venous thromboembolism have dropped to 1% to 3%, and as such, practicing orthopaedic surgeons must be familiar with these medications, including aspirin, heparin, or warfarin, and the use of direct oral anticoagulants (DOACs). DOACs are increasingly being prescribed due to their predictable pharmacokinetics and increased convenience, as they do not require routine monitoring, and 1% to 2% of the general population is currently anticoagulated. Although the introduction of DOACs has yielded additional treatment options, this has also led to confusion and uncertainty regarding treatment, specialized testing, and when and what reversal agents are appropriate. This article provides a basic overview of DOAC medications, their suggested use in the perioperative setting, effects on laboratory testing, and consideration for when and how to use reversal agents in orthopaedic patients.
Keyphrases
- direct oral anticoagulants
- venous thromboembolism
- antiplatelet therapy
- minimally invasive
- patients undergoing
- percutaneous coronary intervention
- coronary artery bypass
- acute coronary syndrome
- end stage renal disease
- atrial fibrillation
- cardiac surgery
- chronic kidney disease
- ejection fraction
- low dose
- surgical site infection
- peritoneal dialysis
- prognostic factors
- clinical practice
- cardiovascular disease
- combination therapy
- thoracic surgery