Management of Non-Vitamin K Antagonist Oral Anticoagulants in the Perioperative Setting

Table 9

Coagulation factor and pro-hemostatic agents.

Concentrate of factors (II, (VII), IX et X): prothrombin complex concentrate, PCC, PPSB (Cofact, Confidex, Octaplex, Beriplex)	25 U/kg, once or two times
Concentrate of activated factors: idem PCC + VIIa, FEIBA, (FEIBA)	50 IE/kg, max 200 IE/kg/day
Factor VIIa: (Novoseven)	Needs further evaluation: 90 g/kg
Antifibrinolytics (Tranexamic acid (Exacyl), Aminocaproïc acid), Desmopressin (Minirin)	No clinical data in this context
Fresh Frozen Plasma (FFP)	Not useful to reverse anticoagulation, expand plasma volume in case of massive transfusion
Protamin, vitamin K	No effect in case of NOACs bleeding

PCC or aPCC utilization is based of few experimental data, can be considered if immediate hemostatic support is essential in case of life-threating bleeding (need for ≥4 red cells transfusions and exogenous cathecolamins for hemodynamic stabilization).