Abstract
Introduction: Proximal aorta interventions impose significant bleeding risk. Patients on concomitant anticoagulation regimens compound the risk of bleeding in any surgery, but especially cardiothoracic interventions. The employment of direct-acting oral anticoagulants (DOAC), namely those that target clotting factors II or X, has expanded at a precipitous rate over the last decade. The emergence of their reversal agents has followed slowly, leaving clinicians with management dilemmas in urgent surgery. We discuss current reversal strategies based on the available published data and our experience with proximal aortic surgery in patients taking DOACs.
Literature Search: We performed a review of literature and present three cases from our experience to offer insight into management strategies that have been historically successful. A review of literature was conducted via PubMed with the following search string: (NOAC or DOAC or TSOAC) and (aorta or aortic or (Stanford and type and a)).
Case Presentation: We present three case presentations that illustrate the importance of DOAC identification and offer management strategies in mitigating associated bleeding risks in urgent or emergent surgeries.
Conclusion: Treatment teams should be aware of the technical limitations of identifying and reversing DOACs. In view of the tendency toward publishing positive outcomes, more scientific rigor is required in the area of emergency DOAC reversal strategies.
Keywords: Anticoagulants, proximal aorta, anticoagulation regimens, cardiothoracic interventions, direct-acting oral anticoagulants, Pub-Med.
Current Pharmaceutical Design
Title:Reversal of DIRECT-ACTING Oral Anticoagulants in Urgent Surgery of the Proximal Aorta: case Series and Review of the literature
Volume: 24 Issue: 38
Author(s): Eric Zimmermann*, Fawzi Ameer, Berhane Worku and Dimitrios Avgerinos
Affiliation:
- Department of Surgery, NewYork-Presbyterian/Queens, Flushing, NY,United States
Keywords: Anticoagulants, proximal aorta, anticoagulation regimens, cardiothoracic interventions, direct-acting oral anticoagulants, Pub-Med.
Abstract: Introduction: Proximal aorta interventions impose significant bleeding risk. Patients on concomitant anticoagulation regimens compound the risk of bleeding in any surgery, but especially cardiothoracic interventions. The employment of direct-acting oral anticoagulants (DOAC), namely those that target clotting factors II or X, has expanded at a precipitous rate over the last decade. The emergence of their reversal agents has followed slowly, leaving clinicians with management dilemmas in urgent surgery. We discuss current reversal strategies based on the available published data and our experience with proximal aortic surgery in patients taking DOACs.
Literature Search: We performed a review of literature and present three cases from our experience to offer insight into management strategies that have been historically successful. A review of literature was conducted via PubMed with the following search string: (NOAC or DOAC or TSOAC) and (aorta or aortic or (Stanford and type and a)).
Case Presentation: We present three case presentations that illustrate the importance of DOAC identification and offer management strategies in mitigating associated bleeding risks in urgent or emergent surgeries.
Conclusion: Treatment teams should be aware of the technical limitations of identifying and reversing DOACs. In view of the tendency toward publishing positive outcomes, more scientific rigor is required in the area of emergency DOAC reversal strategies.
Export Options
About this article
Cite this article as:
Zimmermann Eric *, Ameer Fawzi , Worku Berhane and Avgerinos Dimitrios, Reversal of DIRECT-ACTING Oral Anticoagulants in Urgent Surgery of the Proximal Aorta: case Series and Review of the literature, Current Pharmaceutical Design 2018; 24 (38) . https://dx.doi.org/10.2174/1381612825666181226150006
DOI https://dx.doi.org/10.2174/1381612825666181226150006 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
The Clinical Usefulness of Nuclear Medicine Techniques in the Diagnosis of Vascular Graft Infections
Current Molecular Imaging (Discontinued) Sulfonyl Group-Containing Compounds in the Design of Potential Drugs for the Treatment of Diabetes and Its Complications
Current Medicinal Chemistry Circadian Rhythm and Risk of Hemorrhagic Transformation after Acute Ischemic Stroke Treated with Intravenous Thrombolysis - A Systematic Review
CNS & Neurological Disorders - Drug Targets Evaluation of a Standardized Protocol Using Lepirudin or Argatroban for Heparin-Induced Thrombocytopenia
Cardiovascular & Hematological Agents in Medicinal Chemistry Quantitative Structure-Activity Relationships for Commercially Available Inhibitors of COX-2
Medicinal Chemistry Pediatric Epilepsy Surgery: Neuropsychological and Psychosocial Outcomes
Current Pediatric Reviews Treatment of Hypertension in Chronic Kidney Disease: Does one Size Fit All? A Narrative Review from a Nephrologist’s Perspective
Current Hypertension Reviews Dual Energy Computed Tomography Angiography in the Peripheral Arterial Imaging: A Systematic Review of Image Quality, Radiation Dose and Diagnostic Value
Current Medical Imaging A Retrospective, Multi-Center Cohort Study Evaluating the Severity- Related Effects of Cerebrolysin Treatment on Clinical Outcomes in Traumatic Brain Injury
CNS & Neurological Disorders - Drug Targets Renal Biopsy Research with Implications for Therapy of Glomerulonephritis
Current Drug Therapy A Review on Corrosion Protection of Iron and Steel
Recent Patents on Corrosion Science (Discontinued) Texaphyrins: Tumor Localizing Redox Active Expanded Porphyrins
Anti-Cancer Agents in Medicinal Chemistry Prevention of Intracerebral Haemorrhage
Current Drug Targets SPR-based Fragment Screening: Advantages and Applications
Current Topics in Medicinal Chemistry Colloid Update
Current Pharmaceutical Design CD133+ Glioblastoma Stem-Like Cells Induce Vascular Mimicry in Vivo
Current Neurovascular Research Roles of Renal Proximal Tubule Transport in the Pathogenesis of Hypertension
Current Hypertension Reviews Cardioembolic Stroke Diagnosis Using Blood Biomarkers
Current Cardiology Reviews Neuroprotection of Coenzyme Q10 in Neurodegenerative Diseases
Current Topics in Medicinal Chemistry Pharmaceutical Care: Past, Present and Future
Current Pharmaceutical Design