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Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry.
TH Open. 2020 Apr; 4(2):e127-e137.TO

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.

Authors+Show Affiliations

Anaesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, València, Spain.Anaesthesiology and Critical Care, Hospital Universitario Doctor Peset, València, Spain.Anaesthesiology and Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain.Anaesthesiology and Critical Care, Hospital Miguel Servet, Zaragoza, Spain.Anaesthesiology and Critical Care, Hospital Galdakao-Usánsolo, Bizkaia, Spain.Anaesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, València, Spain.Anaesthesiology and Critical Care, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.Anaesthesiology and Critical Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain.Anaesthesiology and Critical Care, Hospital Universitario Puerta del Mar, Cadiz, Spain.Anaesthesiology and Critical Care, Hospital Lluís Alcanyís, Xàtiva, Spain.Anaesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, València, Spain.Anaesthesiology and Critical Care, Fundació Puigvert, Barcelona, Spain.Anaesthesiology and Critical Care, Hospital Parc Taulí, Sabadell, Spain.Anaesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, València, Spain.Anaesthesiology and Critical Care, Hospital de La Ribera, Alzira, Spain.Anaesthesiology and Critical Care, Hospital Costa del Sol, Marbella, Spain.Anaesthesiology and Critical Care, Hospital Universitario Virgen de la Victoria, Málaga, Spain.Anaesthesiology and Critical Care, Hospital Universitario Doctor Peset, València, Spain.Anaesthesiology and Critical Care, Clínica Universitaria de Navarra, Pamplona, Spain.Anaesthesiology and Critical Care, Hospital Virgen del Rocio, Sevilla, Spain.Anaesthesiology and Critical Care, Hospital Universitario de Móstoles, Madrid, Spain.Anaesthesiology and Critical Care, Complejo Hospitalario de Toledo, Toledo, Spain.Anaesthesiology and Critical Care, Hospital Universitario de Getafe, Madrid, Spain.Anaesthesiology and Critical Care, Hospital La Paz, Madrid, Spain.Anaesthesiology and Critical Care, Hospital de Mataró, Mataró, Spain.Anaesthesiology and Critical Care, Hospital Universitario Marqués de Valdecilla, Santander, Spain.Anaesthesiology and Critical Care, Hospital Universitario Parc de Salut Mar, Barcelona, Spain.Anaesthesiology and Critical Care, Fundació Puigvert, Barcelona, Spain.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32607466

Citation

Ferrandis, Raquel, et al. "Periprocedural Direct Oral Anticoagulant Management: the RA-ACOD Prospective, Multicenter Real-World Registry." TH Open : Companion Journal to Thrombosis and Haemostasis, vol. 4, no. 2, 2020, pp. e127-e137.
Ferrandis R, Llau JV, Sanz JF, et al. Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry. TH Open. 2020;4(2):e127-e137.
Ferrandis, R., Llau, J. V., Sanz, J. F., Cassinello, C. M., González-Larrocha, Ó., Matoses, S. M., Suárez, V., Guilabert, P., Torres, L. M., Fernández-Bañuls, E., García-Cebrián, C., Sierra, P., Barquero, M., Montón, N., Martínez-Escribano, C., Llácer, M., Gómez-Luque, A., Martín, J., Hidalgo, F., ... Sabaté, S. (2020). Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry. TH Open : Companion Journal to Thrombosis and Haemostasis, 4(2), e127-e137. https://doi.org/10.1055/s-0040-1712476
Ferrandis R, et al. Periprocedural Direct Oral Anticoagulant Management: the RA-ACOD Prospective, Multicenter Real-World Registry. TH Open. 2020;4(2):e127-e137. PubMed PMID: 32607466.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry. AU - Ferrandis,Raquel, AU - Llau,Juan V, AU - Sanz,Javier F, AU - Cassinello,Concepción M, AU - González-Larrocha,Óscar, AU - Matoses,Salomé M, AU - Suárez,Vanessa, AU - Guilabert,Patricia, AU - Torres,Luís-Miguel, AU - Fernández-Bañuls,Esperanza, AU - García-Cebrián,Consuelo, AU - Sierra,Pilar, AU - Barquero,Marta, AU - Montón,Nuria, AU - Martínez-Escribano,Cristina, AU - Llácer,Manuel, AU - Gómez-Luque,Aurelio, AU - Martín,Julia, AU - Hidalgo,Francisco, AU - Yanes,Gabriel, AU - Rodríguez,Rubén, AU - Castaño,Beatriz, AU - Duro,Elena, AU - Tapia,Blanca, AU - Pérez,Antoni, AU - Villanueva,Ángeles M, AU - Álvarez,Juan-Carlos, AU - Sabaté,Sergi, AU - ,, Y1 - 2020/06/26/ PY - 2019/12/28/received PY - 2020/04/14/accepted PY - 2020/7/2/entrez PY - 2020/7/2/pubmed PY - 2020/7/2/medline KW - anticoagulant KW - apixaban KW - dabigatran etexilate KW - perioperative period KW - rivaroxaban SP - e127 EP - e137 JF - TH open : companion journal to thrombosis and haemostasis JO - TH Open VL - 4 IS - 2 N2 - 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. SN - 2512-9465 UR - https://www.unboundmedicine.com/medline/citation/32607466/Periprocedural_Direct_Oral_Anticoagulant_Management:_The_RA-ACOD_Prospective,_Multicenter_Real-World_Registry L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0040-1712476 DB - PRIME DP - Unbound Medicine ER -
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