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)

摘要

We read with interest the proposal of the Working Group on Perioperative Haemostasis (GIHP), published in a recent issue of Archives of Cardiovascular Diseases by Pernod et al. [1]. One of the aims of the proposal was to provide information on the use of coagulation tests carried out at the time when emergency surgery is required in patients treated with the direct oral anticoagulants (DOACs) dabigatran or rivaroxaban. The authors pointed out correctly that the data available at the moment are scanty and do not allow firm recommendations. Nevertheless, specific plasma concentrations of dabigatran or rivaroxaban below which urgent surgery can be carried out have been reported [1]. Furthermore, the authors propose that when plasma concentrations are not available, one can rely on the results of the two most commonly available coagulation tests, prothrombin (PT) and activated partial thromboplastin time (aPTT) [1]. Specifically, the authors mentioned that < 30 ng/mL for either drug is safe and surgery can be carried out without significant bleeding risk. Likewise, they proposed that a PT or aPTT ratio < 1.2 can be taken as a threshold limit to perform surgery [1].