Introduction. Vitamin K antagonist warfarin or the new oral anticoagulants (NOAC), a direct thrombin or factor Xa inhibitors, are increasingly prescribed for long-term prophylaxis of thrombotic complications. It is recognized that it is still difficult to evaluate the specific effects of NOAC’s on the clotting system by laboratory tests. There is also the lack of antidotes for rapid reversion of NOAC.
Methods. A search on PubMed has been conducted using “anticoagulants” as a keyword. Publications from the years 2017-2019 were selected for the review.
Objective. To provide guidance on anticoagulant treatment before elective interventions and emergency procedures, correction of coagulation abnormalities during bleeding, evaluation of the anticoagulant effect on the clotting system.
Results. The efficacy of NOAC is not inferior to warfarin. Its consumption is safer due to a lower risk of bleeding. If the risk of bleeding is low before the planned intervention, the use of anticoagulants is not interrupted. NOACs administration is interrupted between 1 to 3 days prior to the elective intervention, taking into account the half-life, interactions with other medical products, liver and kidney function, age and body weight of the patient. In most cases, bridging therapy is not necessary after discontinuation of NOAC. NOAC does not show obvious changes in routine coagulation monitoring studies. In laboratory studies, the ability to detect NOAC in the blood remains limited and the therapeutic window is not clear. The detection is required only in specific clinical situations. If the patient does not develop bleeding and the intervention may be delayed, the reverse agents are not allocated. At present, there is an antidote to the reversal after dabigatran exposure. In other cases, prothrombin complex concentrate is given.
Conclusions. Patients treated with anticoagulants can be appropriately prepared for safe elective and urgent interventions taking into account the pharmacological properties of NOAC. Evaluation of the clotting function when necessary is also feasible. Indications for reversal of anticoagulants are sufficiently clear. The lack of NOAC antidotes is compensated by other reverse agents.
