Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry
| العنوان: | Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry |
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| المؤلفون: | Blanca Tapia, Patricia Guilabert, Vanessa Suárez, Óscar González-Larrocha, Cristina Martínez-Escribano, Javier F. Sanz, Elena Duro, Consuelo García-Cebrián, Antoni Pérez, Juan-Carlos Álvarez, Juan V. Llau, Manuel Llácer, Ángeles M. Villanueva, A. Gómez-Luque, Concepción Cassinello, Sergi Sabaté, Julia Martín, Esperanza Fernández-Bañuls, Marta Barquero, R. Ferrandis, Beatriz Castaño, Salomé M. Matoses, Nuria Montón, Pilar Sierra, Francisco Cañadillas Hidalgo, Luís-Miguel Torres, Rubén Rodríguez, Gabriel Yanes |
| المصدر: | TH Open, Vol 04, Iss 02, Pp e127-e137 (2020) TH Open: Companion Journal to Thrombosis and Haemostasis |
| بيانات النشر: | Georg Thieme Verlag KG, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Rivaroxaban, medicine.drug_class, business.industry, anticoagulant, perioperative period, Anticoagulant, apixaban, Perioperative, Odds ratio, dabigatran etexilate, Confidence interval, Dabigatran, chemistry.chemical_compound, chemistry, lcsh:RC666-701, Edoxaban, Internal medicine, medicine, Original Article, Apixaban, business, rivaroxaban, medicine.drug |
| الوصف: | 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. |
| تدمد: | 2512-9465 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f8d5728f6d45631b046a9c363aa62f52Test https://doi.org/10.1055/s-0040-1712476Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....f8d5728f6d45631b046a9c363aa62f52 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 25129465 |
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