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


ABSTRACT: Introduction ?There is scarce real-world experience regarding direct oral anticoagulants (DOACs) perioperative management. No study before has linked bridging therapy or DOAC-free time (pre-plus postoperative time without DOAC) with outcome. The aim of this study was to investigate real-world management and outcomes. Methods ?RA-ACOD is a prospective, observational, multicenter registry of adult patients on DOAC treatment requiring surgery. Primary outcomes were thrombotic and hemorrhagic complications. Follow-up was immediate postoperative (24-48?hours) and 30 days. Statistics were performed using a univariate and multivariate analysis. Data are presented as odds ratios (ORs [95% confidence interval]). Results ?From 26 Spanish hospitals, 901 patients were analyzed (53.5% major surgeries): 322 on apixaban, 304 on rivaroxaban, 267 on dabigatran, 8 on edoxaban. Fourteen (1.6%) patients suffered a thrombotic event, related to preoperative DOAC withdrawal (OR: 1.57 [1.03-2.4]) and DOAC-free time longer than 6 days (OR: 5.42 [1.18-26]). Minor bleeding events were described in 76 (8.4%) patients, with higher incidence for dabigatran (12.7%) versus other DOACs (6.6%). Major bleeding events occurred in 17 (1.9%) patients. Bridging therapy was used in 315 (35%) patients. It was associated with minor (OR: 2.57 [1.3-5.07]) and major (OR: 4.2 [1.4-12.3]) bleeding events, without decreasing thrombotic events. Conclusion ?This study offers real-world data on perioperative DOAC management and outcomes in a large prospective sample size to date with a high percentage of major surgery. Short-term preprocedural DOAC interruption depending on the drug, hemorrhagic risk, and renal function, without bridging therapy and a reduced DOAC-free time, seems the safest practice.

SUBMITTER: Ferrandis R 

PROVIDER: S-EPMC7319799 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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

Ferrandis Raquel R   Llau Juan V JV   Sanz Javier F JF   Cassinello Concepción M CM   González-Larrocha Óscar Ó   Matoses Salomé M SM   Suárez Vanessa V   Guilabert Patricia P   Torres Luís-Miguel LM   Fernández-Bañuls Esperanza E   García-Cebrián Consuelo C   Sierra Pilar P   Barquero Marta M   Montón Nuria N   Martínez-Escribano Cristina C   Llácer Manuel M   Gómez-Luque Aurelio A   Martín Julia J   Hidalgo Francisco F   Yanes Gabriel G   Rodríguez Rubén R   Castaño Beatriz B   Duro Elena E   Tapia Blanca B   Pérez Antoni A   Villanueva Ángeles M ÁM   Álvarez Juan-Carlos JC   Sabaté Sergi S  

TH open : companion journal to thrombosis and haemostasis 20200401 2


<b>Introduction</b>  There is scarce real-world experience regarding direct oral anticoagulants (DOACs) perioperative management. No study before has linked bridging therapy or DOAC-free time (pre-plus postoperative time without DOAC) with outcome. The aim of this study was to investigate real-world management and outcomes. <b>Methods</b>  RA-ACOD is a prospective, observational, multicenter registry of adult patients on DOAC treatment requiring surgery. Primary outcomes were thrombotic and hemo  ...[more]

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