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Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry.

Raquel Ferrandis1, Juan V Llau2, Javier F Sanz3

  • 1Anaesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, València, Spain.

TH Open : Companion Journal to Thrombosis and Haemostasis
|July 2, 2020
PubMed
Summary

Managing direct oral anticoagulants (DOACs) around surgery requires careful planning. This study found that longer DOAC-free times increase thrombotic risks, while bridging therapy raises bleeding risks.

Keywords:
anticoagulantapixabandabigatran etexilateperioperative periodrivaroxaban

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Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Limited real-world data exists on perioperative management of direct oral anticoagulants (DOACs).
  • No prior studies have linked bridging therapy or DOAC-free time to patient outcomes.

Purpose of the Study:

  • To investigate real-world management strategies for DOACs in patients undergoing surgery.
  • To analyze the impact of perioperative DOAC management on thrombotic and hemorrhagic complications.

Main Methods:

  • Prospective, observational, multicenter registry (RA-ACOD) of 901 adult patients on DOACs requiring surgery.
  • Primary outcomes included thrombotic and hemorrhagic complications assessed at 24-48 hours and 30 days post-operation.
  • Statistical analysis involved univariate and multivariate methods, presenting data as odds ratios (ORs) with 95% confidence intervals.

Main Results:

  • Thrombotic events (1.6%) were associated with preoperative DOAC withdrawal and DOAC-free times exceeding 6 days (OR: 5.42).
  • Minor bleeding occurred in 8.4% of patients, with higher incidence for dabigatran.
  • Bridging therapy (used in 35%) was linked to increased minor (OR: 2.57) and major (OR: 4.2) bleeding events without reducing thrombotic events.

Conclusions:

  • Real-world data from a large prospective cohort indicate that short-term DOAC interruption, tailored to drug, bleeding risk, and renal function, is safest.
  • Avoiding bridging therapy and minimizing DOAC-free time appear to be crucial for safe perioperative management.
  • This study provides significant insights into DOAC perioperative management for a substantial number of patients, including those undergoing major surgery.