Apixaban Discontinuation for Invasive Or major Surgical procedures (ADIOS): A prospective cohort study.

Area of Science:

• Pharmacology
• Cardiology
• Perioperative Medicine

Background:

• Apixaban's pharmacokinetics suggest 48-hour cessation before surgery may be safe.
• Limited data exists from naturalistic settings regarding residual apixaban exposure.
• This study aimed to quantify apixaban levels in patients undergoing surgery after holding the medication.

Purpose of the Study:

• To measure residual apixaban plasma concentration and anti-Xa activity in patients discontinuing the drug before surgery.
• To assess the safety and efficacy of a 48-hour apixaban discontinuation period in a real-world setting.

Main Methods:

• Prospective, observational study design.
• Measurement of apixaban plasma concentration and anti-Xa activity at steady-state and immediately before surgery.
• Physician discretion for apixaban cessation and resumption management.

Main Results:

• 111 patients provided paired blood samples.
• 94% of patients had apixaban concentrations ≤ 30 ng/mL 48 hours prior to surgery.
• Low rates of bleeding (1 nonmajor) and thromboembolic events (1 VTE, 1 stroke) were observed.

Conclusions:

• Apixaban discontinuation for at least 48 hours results in clinically insignificant anticoagulation before surgery in a heterogeneous, naturalistic setting.
• The findings support the safety of a 48-hour apixaban washout period for surgical procedures.