Background: Due to increasing use of new oral anticoagulants (NOACs), clinicians are faced more and more frequently with clinical issues related to these drugs. Objective: The objective of this publication is to make practical suggestions for the perioperative management of NOACs as well as for their handling in overdoses and bleedings. Recommendations: In elective surgery and creatinine clearance ≥ 50 ml/min, a NOAC should be discontinued 24-36 h before the intervention, and even earlier in case of reduced kidney function. In emergency interventions that cannot be delayed, the management is dependent on the NOAC plasma levels. With levels ≤ 30 ng/ml, surgery can be performed. With levels >30 ng/ml, reversal agents should be considered. In low bleeding risk surgery, NOACs can be re-started 24 h after the intervention, which is prolonged to 48-72 h after surgery with high bleeding risk. In case of NOAC overdose and minor bleedings, temporary discontinuation and supportive care are usually sufficient to control the situation. In severe or life-threatening bleedings, nonspecific and specific reversal agents should be considered.

中文翻译：

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麻醉学中的 NOAC

背景：由于越来越多地使用新型口服抗凝剂 (NOAC)，临床医生越来越频繁地面临与这些药物相关的临床问题。目的：本出版物的目的是为 NOAC 的围手术期管理以及过量和出血的处理提供实用建议。建议：在择期手术和肌酐清除率 ≥ 50 ml/min 时，应在干预前 24-36 小时停用 NOAC，如果肾功能下降，应更早停用。在不能延迟的紧急干预中，管理取决于 NOAC 血浆水平。水平≤30 ng/ml，可以进行手术。当水平 >30 ng/ml 时，应考虑使用逆转剂。在低出血风险手术中，可以在干预后 24 小时重新开始使用 NOAC，手术后延长至48-72小时，出血风险高。在 NOAC 过量和轻微出血的情况下，暂时停药和支持治疗通常足以控制情况。在严重或危及生命的出血中，应考虑使用非特异性和特异性逆转剂。