Portal de investigación
Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry.
Fecha de publicación:
Fecha Ahead of Print:
Autores de IIS La Fe
Participantes ajenos a IIS La Fe
- Llau JV
- Sanz JF
- Cassinello CM
- González-Larrocha Ó
- Suárez V
- Guilabert P
- Torres LM
- Fernández-Bañuls E
- Sierra P
- Barquero M
- Martínez-Escribano C
- Llácer M
- Gómez-Luque A
- Martín J
- Hidalgo F
- Yanes G
- Rodríguez R
- Castaño B
- Duro E
- Tapia B
- Pérez A
- Villanueva ÁM
- Álvarez JC
- Sabaté S
Grupos
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.
Datos de la publicación
- ISSN/ISSNe:
- 2567-3459, 2512-9465
- Tipo:
- Article
- Páginas:
- 127-137
- PubMed:
- 32607466
TH OPEN GEORG THIEME VERLAG KG
Documentos
- No hay documentos
Filiaciones
Keywords
- anticoagulant, apixaban, dabigatran etexilate, perioperative period, rivaroxaban
Cita
FERRANDIS R,Llau JV,Sanz JF,Cassinello CM,González Ó,MATOSES SM,Suárez V,Guilabert P,Torres LM,Fernández E,GARCÍA C,Sierra P,Barquero M,MONTÓN N,Martínez C,Llácer M,Gómez A,Martín J,Hidalgo F,Yanes G,Rodríguez R,Castaño B,Duro E,Tapia B,Pérez A,Villanueva ÁM,Álvarez JC,Sabaté S. Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry. TH Open. 2020. 4. (2):p. 127-137.