Comments on: Laboratory tests for the management of major bleeding complications and emergency surgery in patients on long-term treatment with direct oral anticoagulants: Proposals of the Working Group on Perioperative Haemostasis (GIHP): A rebuttal

摘要

We appreciate the pertinent comment from Dr Tripodi [1] on the proposals of the Working Group on Perioperative Haemostasis, regarding management of major bleeding and emergency surgery in patients on long-term treatment with direct anticoagulants [2]. Several clarifications need to be made. As highlighted by Dr Tripodi, recommendations cannot be established because of the lack of data in the emergency situation. Therefore, several mundane proposals can be put forward, such as: 'ideally, surgery must be delayed'; but how many times, and for what purpose? In our working group, we decided that experts must develop an opinion precisely for such cases where there is no clear guidance. Moreover, we addressed the proposals for emergency surgery (i.e. surgery that must be done within 48 hours) that, in instances such as peritonitis, cannot be delayed.