Management of novel oral anticoagulants in emergency and trauma surgery.
BACKGROUND
The compelling safety, efficacy and predictable effect of novel oral anticoagulants (NOACs) is driving a rapid expansion in their therapeutic indications. Management of the increasing number of patients on those new agents in the setting of emergency or trauma surgery can be challenging and the absence of specific reversal agents has been a matter of concern. This review summarises the key principles that underpin the management of those patients with a particular emphasis on the recent development of specific antidotes.


FINDINGS
As of 2015, a new line of antidotes, specific for these drugs, are at different stages of their development with their release imminent. However, as NOACs are innately reversible due to their short half-life, the use of reversal agents will probably be restricted to a few exceptional cases. Post-marketing surveillance will be paramount to better clarify the role of these promising drugs.


CONCLUSIONS
Management of patients on NOACs in the context of emergency or trauma surgery relies on best supportive care in combination with the blood products and/or specific antidotes as required. Familiarity with the new reversal agents is essential but further evidence on their indications, safety and efficacy as well as consensus guidelines are warranted prior to widespread adoption.
['Pinho-Gomes|Ana-Catarina|AC|', 'Hague|Adam|A|', 'Ghosh|Jonathan|J|']
D000284:Administration, Oral D061067:Antibodies, Monoclonal, Humanized D000925:Anticoagulants D000931:Antidotes D001120:Arginine D001779:Blood Coagulation Factors D004638:Emergency Treatment D005260:Female D006801:Humans D008297:Male D010879:Piperazines D019106:Postoperative Hemorrhage D011300:Preoperative Care D011322:Primary Prevention D011379:Prognosis D018570:Risk Assessment D016896:Treatment Outcome D014947:Wounds and Injuries
Novel oral anticoagulants Trauma Reversal agents Antidotes Emergency surgery