Chirurgie en urgence: Cas d'une patientec sous anticoagulant oral direct

A 68-year-old woman effectively treated by rivaroxaban (Xarelto®) for cardiac arrhythmia atrial fibrillation felt intense abdominal pains with vomitings. A bowel obstruction related to adhesion was diagnosed requiring a surgery in emergency. It was necessary to stop the NOAC (new oral anticoagulant) and therefore to determine delay before surgery. There are no recommendations on the management of patients treated by long term NOAC except suggested proposals from groups of experts. Evaluation of common coagulation tests (PT, aPTT) and NOAC plasma concentration were performed. Although the latter was high the surgery intervention could not be postpone. Coagulation factors were delivered to anticipate any haemorrhagic event but finally were not used. Conclusion: NOAC do not require routine coagulation monitoring but no antidote is available if an overdose happens, it is only clinically detectable. The NOAC must be cautiously prescribed and are a therapeutic alternative to vitamin K antagonists.