Perioperative interruption of direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation: A comparative analysis

Abstract Background There is a paucity of studies comparing postoperative thromboembolic and major bleeding complications following perioperative interruption of the direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). Objective/Methods We conducted a retrospective cohort study to co...

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Autores principales:	Joseph R. Shaw, Tinghua Zhang, Gregoire Le Gal, James Douketis, Marc Carrier
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2020
Materias:	anticoagulants apixaban atrial fibrillation dabigatran perioperative period postoperative complications Diseases of the blood and blood-forming organs RC633-647.5
Acceso en línea:	https://doaj.org/article/2de3804353684c9c85658ae9f35b9b93
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spelling	oai:doaj.org-article:2de3804353684c9c85658ae9f35b9b932021-11-15T06:10:44ZPerioperative interruption of direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation: A comparative analysis2475-037910.1002/rth2.12285https://doaj.org/article/2de3804353684c9c85658ae9f35b9b932020-01-01T00:00:00Zhttps://doi.org/10.1002/rth2.12285https://doaj.org/toc/2475-0379Abstract Background There is a paucity of studies comparing postoperative thromboembolic and major bleeding complications following perioperative interruption of the direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). Objective/Methods We conducted a retrospective cohort study to compare postoperative thromboembolic and major bleeding outcomes following perioperative interruption of DOACs and VKAs in patients with atrial fibrillation. The primary efficacy and safety outcomes were the 30‐day postoperative rates of arterial thromboembolic events (ATEs) and major bleeding, respectively. The secondary outcomes included the 30‐day rates of clinically relevant nonmajor bleeding (CRNMB) and overall mortality. Thromboembolic, major bleeding, and mortality outcomes were independently adjudicated. Multivariable mixed‐effects logistic‐regression models were used to adjust for potential confounding variables between the DOAC and VKA cohorts. Results A total of 325 DOAC patients undergoing 351 procedures and 199 VKA patients undergoing 221 procedures were included. The 30‐day ATE rate was 0.57% (95% confidence interval [CI], 0.27‐0.8) in the DOAC cohort. There were no ATEs in the VKA cohort. The 30‐day rates of major bleeding were 0.57% (95% CI, 0.27‐0.8) and 3.62% (95% CI, 0‐7.3) in the DOAC and the VKA cohorts, respectively. There were significantly more postoperative major bleeding events in the VKA cohort. The 30‐day rate of CRNMB was 4.27% (95% CI, 4.15‐4.42) in the DOAC cohort and 4.52% (95% CI, 3.67‐5.38) in the VKA cohort. There were 2 deaths in the VKA cohort, one of which was deemed to be a fatal nonsurgical bleeding event. Conclusions The perioperative interruption of VKAs may be associated with higher postoperative major bleeding rates as compared to DOACs. Careful postoperative reinitiation and monitoring of VKA anticoagulation may be warranted following surgical procedures.Joseph R. ShawTinghua ZhangGregoire Le GalJames DouketisMarc CarrierWileyarticleanticoagulantsapixabanatrial fibrillationdabigatranperioperative periodpostoperative complicationsDiseases of the blood and blood-forming organsRC633-647.5ENResearch and Practice in Thrombosis and Haemostasis, Vol 4, Iss 1, Pp 131-140 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	anticoagulants apixaban atrial fibrillation dabigatran perioperative period postoperative complications Diseases of the blood and blood-forming organs RC633-647.5
spellingShingle	anticoagulants apixaban atrial fibrillation dabigatran perioperative period postoperative complications Diseases of the blood and blood-forming organs RC633-647.5 Joseph R. Shaw Tinghua Zhang Gregoire Le Gal James Douketis Marc Carrier Perioperative interruption of direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation: A comparative analysis
description	Abstract Background There is a paucity of studies comparing postoperative thromboembolic and major bleeding complications following perioperative interruption of the direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). Objective/Methods We conducted a retrospective cohort study to compare postoperative thromboembolic and major bleeding outcomes following perioperative interruption of DOACs and VKAs in patients with atrial fibrillation. The primary efficacy and safety outcomes were the 30‐day postoperative rates of arterial thromboembolic events (ATEs) and major bleeding, respectively. The secondary outcomes included the 30‐day rates of clinically relevant nonmajor bleeding (CRNMB) and overall mortality. Thromboembolic, major bleeding, and mortality outcomes were independently adjudicated. Multivariable mixed‐effects logistic‐regression models were used to adjust for potential confounding variables between the DOAC and VKA cohorts. Results A total of 325 DOAC patients undergoing 351 procedures and 199 VKA patients undergoing 221 procedures were included. The 30‐day ATE rate was 0.57% (95% confidence interval [CI], 0.27‐0.8) in the DOAC cohort. There were no ATEs in the VKA cohort. The 30‐day rates of major bleeding were 0.57% (95% CI, 0.27‐0.8) and 3.62% (95% CI, 0‐7.3) in the DOAC and the VKA cohorts, respectively. There were significantly more postoperative major bleeding events in the VKA cohort. The 30‐day rate of CRNMB was 4.27% (95% CI, 4.15‐4.42) in the DOAC cohort and 4.52% (95% CI, 3.67‐5.38) in the VKA cohort. There were 2 deaths in the VKA cohort, one of which was deemed to be a fatal nonsurgical bleeding event. Conclusions The perioperative interruption of VKAs may be associated with higher postoperative major bleeding rates as compared to DOACs. Careful postoperative reinitiation and monitoring of VKA anticoagulation may be warranted following surgical procedures.
format	article
author	Joseph R. Shaw Tinghua Zhang Gregoire Le Gal James Douketis Marc Carrier
author_facet	Joseph R. Shaw Tinghua Zhang Gregoire Le Gal James Douketis Marc Carrier
author_sort	Joseph R. Shaw
title	Perioperative interruption of direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation: A comparative analysis
title_short	Perioperative interruption of direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation: A comparative analysis
title_full	Perioperative interruption of direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation: A comparative analysis
title_fullStr	Perioperative interruption of direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation: A comparative analysis
title_full_unstemmed	Perioperative interruption of direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation: A comparative analysis
title_sort	perioperative interruption of direct oral anticoagulants and vitamin k antagonists in patients with atrial fibrillation: a comparative analysis
publisher	Wiley
publishDate	2020
url	https://doaj.org/article/2de3804353684c9c85658ae9f35b9b93
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Perioperative interruption of direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation: A comparative analysis

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