March 25, 2015
The cardiology community has recently witnessed a rapid expansion in the available therapies for non-valvular atrial fibrillation (AF) with approval of the “novel oral anticoagulants” (NOACs), which include dabigatran (Pradaxa™), rivaroxaban (Xarelto™), apixaban (Eliquis™) and edoxaban (Savaysa, Lixiana™). As the medical community began to incorporate these agents into routine clinical practice, questions regarding periprocedural management and reversal during bleeding arose, largely because specific reversal agents are not available and protocols for periprocedural management have not been established. As such, clinicians have been guided by expert opinions and consensus statements on the topic. This Tip of the Month from the SCAI Quality Improvement Committee provides a concise summary of these recommendations as they pertain to the management of patients presenting for invasive procedures, including but not limited to cardiac catheterization and percutaneous coronary intervention, as well as the available reversal options. We recommend a multi-subspecialty approach for the development of an institution-specific strategy for NOAC management in the periprocedural setting and during bleeding complications.