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Direct Oral Anticoagulant Use Early After Cardiac Surgery: A Retrospective Cohort Study
Jung-Jin Wu1, Jessie Jiang2, Jian Ye3
1Department of Pharmacy, Ridge Meadows Hospital, and Faculty of Pharmaceutical Sciences, Maple Ridge, British Columbia, Canada.
CJC Open
|April 8, 2024
Summary
Direct oral anticoagulants (DOACs) were prescribed to 30% of patients post-cardiac surgery, with no significant differences in bleeding or hospital stay compared to warfarin. This study provides insights into DOAC use in this patient population.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Limited literature exists on direct oral anticoagulant (DOAC) use post-cardiac surgery.
- Cardiac surgery patients are often excluded from major clinical trials.
- Guidance for early DOAC prescribing after cardiac surgery is needed.
Purpose of the Study:
- To compare in-hospital DOAC use versus warfarin early after cardiac surgery.
- To identify factors associated with DOAC prescribing.
- To evaluate postoperative length of stay and bleeding events.
Main Methods:
- Retrospective cohort study of adult patients receiving anticoagulation post-cardiac surgery.
- Compared patients on DOACs versus warfarin.
- Excluded patients with DOAC contraindications.
Main Results:
- 30% of 210 patients received DOACs upon discharge; 70% received warfarin.
- Apixaban was the most common DOAC; median initiation was postoperative day 5.
- No significant differences in postoperative length of stay or in-hospital bleeding between groups.
Conclusions:
- Direct oral anticoagulants (DOACs) are used in about one-third of patients after cardiac surgery.
- DOAC use was associated with older age, less valvular disease, preoperative DOAC use, and isolated CABG.
- Bleeding and length of stay did not differ between DOAC and warfarin groups.
