Management of Non-Vitamin K Antagonist Oral Anticoagulants in the Perioperative Setting
Table 1
Summary of approved indications, posology and dose adaptation of the different NOACs.
Dabigatran etexilate (Pradaxa)
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
VTE Prophylaxis
(i) 220 mg/day (2 capsules of 110 mg OD) or (ii) 150 mg/day (2 capsules of 75 mg OD) if CrCl 30–50 mL/min, if >75 years, if verapamil, amiodarone and quinidine THR: 28–35 days TKR: 10 days
5 mg/day (1 tablet of 2.5 mg BID) THR: 32–38 days TKR: 10 days
Non-valvular atrial fibrillation
(i) 300 mg/day (1 capsule of 150 mg BID) (ii) 220 mg/day (EU) (1 capsule 110 mg BID) (a) if >80 y or verapamil 150 mg/day (US) (1 capsule of 75 mg BID) (b) if CrCl between 15–30 mL/min (c) if dronedarone/ketoconazole (US)
(i) 20 mg/day (1 tablet of 20 mg OD) (ii) 15 mg/day (1 tablet of 15 mg OD) if CrCl between 15–49 mL/min
(i) 10 mg/day (1 tablet of 5 mg BID) (ii) 5 mg/day (1 tablet of 2.5 mg BID) if at least 2 of the following conditions: ≥80 years, ≤60 kg or serum creatinine ≥1.5 mg/dL; or if CrCl 15–29 mL/min
VTE treatment and secondary prophylaxis
(i) 150 mg BID after 5–10 days parenteral anticoagulation (ii) 1 capsule 75 mg BID if CrCl <30 mL/min (US) (iii) Adopted indication CHMP° (april 2014) (EU)
(i) Treatment phase: 30 mg/day (1 tablet of 15 mg BID) for 21 days (ii) Secondary prevention: 20 mg/day (1 tablet of 20 mg OD) 15 mg/day (1 tablet of 15 mg OD) if CrCl between 15–49 mL/min and the risk of bleeding outweighs the risk of recurrent DVT or PE
✗
Prevention of atherothrombotic events after ACS with elevated cardiac biomarkers
✗
5 mg/day (1 tablet of 2.5 mg BID) in association with ASA (75–100 mg) alone or ASA + clopidogrel (75 mg)
✗
✗: Off-label; BID: twice daily; CrCl: creatinine clearance; VTE: venous thromboembolism; OD: once daily; PE: pulmonary embolism; THR: total hip replacement TKR: total knee replacement; °Committee for Medicinal Products for Human Use (CHMP), ASA: acetylsalicylic acid.
