Introduction: Novel oral anti-coagulants (NOACs) are set to become increasingly common in ENT patients. January 2015 NICE guidelines recommend rivaroxaban for up to 1 year after a myocardial infarction. This review sets out a guide to managing the new anticoagulants in acute and elective ENT patients.
Methods: Medline/ EMBASE searches and reviews of specialist society guidelines and expert recommendations were conducted.
Results: Limited RCT evidence exists to date on peri-operative management and emergency reversal. We have therefore condensed society guidelines and expert recommendations to create a succinct, practical guide to the peri-operative and emergency management of these patients.
Conclusion: Novel anticoagulants are poised to take over from warfarin (at least 1% of the UK adult population) for most indications. Yet in practice most surgeons have had limited experience with them. This review and ‘surgeon’s guide’ aims to set out a best-evidence foundation from which to respond to the emerging challenge.