The bridging conundrum: perioperative management of direct oral anticoagulants for venous thromboembolism

J Thromb Haemost. 2023 Apr;21(4):780-786. doi: 10.1016/j.jtha.2022.12.024. Epub 2023 Jan 2.

Abstract

Most patients diagnosed with venous thromboembolism (VTE) are currently treated with direct oral anticoagulants (DOACs). Before an invasive procedure or surgery, clinicians face the challenging decision of how to best manage DOACs. Should the DOAC be held, for how long, and are there instances where bridging with other anticoagulants should be considered? Although clinical trials indicate that most patients taking DOACs for atrial fibrillation do not require bridging anticoagulation, the optimal strategy for patients with a history of VTE is undefined. In this review, we present a case-based discussion for DOAC interruption perioperatively in patients receiving anticoagulation for management of VTE.

Keywords: bleeding; direct-acting oral anticoagulants; perioperative medicine; procedure; venous thromboembolism.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / drug therapy
  • Blood Coagulation
  • Hemorrhage / drug therapy
  • Humans
  • Venous Thromboembolism* / diagnosis
  • Venous Thromboembolism* / drug therapy
  • Venous Thromboembolism* / prevention & control

Substances

  • Anticoagulants