Cataract surgery xarelto explains one of the drugs used in the management of direct oral anticoagulants (DOACs) among patients who need short and long-term anticoagulation as the basis for writing this article.
Cataract Surgery Xarelto
We need to know that cataracts are a major cause of blindness in the world. Cataracts occur when the natural lens fogs in your eyes. After the cataract is formed, the lens becomes increasingly blurry because the cataract interferes with the light entering your retina. Cataracts are a natural process. In the Indonesian dictionary, cataract is an eye disease that causes the lens of the eye to become cloudy. With the opacification of the lens inside the eye, cataracts can cause a decrease in vision. You can have cataracts in one eye or both. Cataracts can occur at any age, but in general cataracts are considered part of the aging process. The incidence of cataracts is even higher in those aged over 75 years. However, the good news about cataract treatments is very successful with the latest surgical techniques.
Rivaroxaban (Xarelto) is one of the drugs used in the management of direct oral anticoagulants (DOACs). Direct oral anticoagulants (DOACs) are widely used among patients who need short and long-term anticoagulation, mainly because of their ease of use and lack of monitoring requirements. Rivaroxaban (Xarelto) is an oral anticoagulant that prevents the formation of fibrin clots which are part of the prothrombinase complex to inactivate platelets and degrade fibrinogen to fibrin. Pharmacokinetics Rivaroxaban is given orally and quickly absorbed. With 92% -95% protein binding, rivaroxaban is mostly bound to albumin. Rivaroxaban reaches peak concentrations in plasma for up to two to four hours. The half-life of the drug is usually between five and nine hours, except for the elderly, in this case, the half-life takes place between eleven and thirteen hours. Rivaroxaban has liver metabolism, via the enzymes CYP3A4 and CYP2J2, and is excreted, both as unchanged drugs and inactive metabolites, 66% through urine and 28% through feces. Rivaroxaban is a substrate of ABCG2 removers and P-glycoprotein transporter proteins. Another unique application of rivaroxaban is that it can be used both to treat DVT or PE and to prevent recurrence of both. To treat DVT or PE, rivaroxaban is prescribed for 21 days at a dose of 15 mg orally every 12 hours, followed by a dose of 20 mg orally every day for three months. Finally, to reduce the recurrent risk of DVT and PE, patients are advised to take rivaroxaban 20 mg orally every day for a long period of time.
With increasing use of DOAC, it is important for doctors to manage patients with the drug in the perioperative period, while balancing the risk of bleeding with thromboembolic events. Management of patients in DOAC in the perioperative period involves assessing the risk of thromboembolic events compared to the relative risk of bleeding if the drug is continued. As with warfarin, in minor operations or procedures, DOACs do not need to be stopped, although evidence to support the practice is not strong. The risk of bleeding is determined by invasiveness and timeliness of the procedure or surgery. Patients with a high risk of bleeding in the perioperative period require interruptions in their anticoagulation, but the risk of thromboembolic complications increases. Individuals with very high thromboembolic risk such as those with recent ischemic cerebrovascular accidents are advised to delay elective surgery until thromboembolic risk has decreased to the baseline. In addition, individuals with atrial fibrillation with suboptimal anticoagulation in the month before surgery are advised to delay such operations to reduce the relative thrombotic risk. Eye cataract surgery is considered a low risk procedure. Other risky procedures for low bleeding include abdominal hernia repair, abdominal hysterectomy, axillary node dissection, and bronchoscopy with or without biopsy.
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As reference Cataract Surgery Xarelto please read on Wikipedia about the Rivaroxaban