RT Journal Article SR Electronic T1 Periprocedural management of patients receiving novel oral anticoagulants JF European Journal of Hospital Pharmacy JO Eur J Hosp Pharm FD British Medical Journal Publishing Group SP 292 OP 297 DO 10.1136/ejhpharm-2016-001088 VO 25 IS 6 A1 Arias Pou, Paloma A1 González, Aquerreta A1 Martínez, Luis José Prieto A1 Latorre, Amaya Delgado A1 Alonso, María Serrano YR 2018 UL http://ejhp.bmj.com/content/25/6/292.abstract AB Background Non-vitamin K oral antagonists are being increasingly used. However, broad clinical experience with them is lacking.Objectives To review guidelines and evidence for the use of non-vitamin K oral antagonists in the periprocedural environment.Results Despite the clear advantages of vitamin K oral antagonists, their use can entail risks owing to the scarcity of reversal agents. Consensus has been reached about postoperative resumption, which is recommended at 24 hours and 48–72 hours, respectively, after low-risk and high-risk bleeding surgery. Bridging with heparin is recommended in patients with a high risk of thrombosis. Urgent interventions should ideally take place 24 hours after the last dose intake. Major discrepancies exist between the American and the European recommendations for neuraxial procedures. The American proposals recommend suspending the drug for five half-lives, whereas the European approaches suggest suspension of just two half-lives. Suggestions for perioperative discontinuation vary widely. Some authors recommend a longer time of resumption for patients with renal impairment. All agree that there should be an increase in the number of days of interruption in high-risk bleeding procedures versus low-risk bleeding procedures.Conclusions A diverse number of approaches have been suggested for perioperative management of novel oral antagonists. American recommendations tend to be more rigorous than those of Europe. A need for more studies that measure health outcomes after the use of these drugs would be indispensable.