Novel (oral) anticoagulant challenges in surgery

Non-vitamin K oral anticoagulants (NOACs) are a relatively recent therapeuticmodality for the prevention of systemic thromboembolic complications of atrial fibrillation and the prevention and management of venous thromboembolic disease. Approved indications for this class of anticoagulants are likely to further expand as the results of ongoing and new clinical trials are published and clinical experience grows. Despite their convenience compared with traditionalmethods of anticoagulation, there remain a few potential pitfalls associated with their use in the perioperative setting. In particular, there is limited experience and evidence base regarding anticoagulant management in the perioperative setting, especially given the different NOACs available, which in turn are different from the classical anticoagulants. This narrative review synthesizes the recent advances in development of specific NOAC reversal
agents and the understanding of the complexities of laboratorymeasurement of NOAC anticoagulant effects, and aims to provide practicing clinicians with basic evidencebased tools for perioperative management of patients taking NOACs.