Management of urgent invasive procedures in patients treated with direct oral anticoagulants: An observational registry analysis.
Activated prothrombin complex concentrates
Anticoagulant
Apixaban
Bleeding
Dabigatran
Delay
Direct oral anticoagulant
Prothrombin complex concentrates
Rivaroxaban
Urgent procedure
Journal
Thrombosis research
ISSN: 1879-2472
Titre abrégé: Thromb Res
Pays: United States
ID NLM: 0326377
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
received:
23
02
2022
revised:
07
06
2022
accepted:
14
06
2022
pubmed:
6
7
2022
medline:
20
7
2022
entrez:
5
7
2022
Statut:
ppublish
Résumé
Patients treated with direct oral anticoagulants (DOACs) may require urgent procedures. Managing these patients is challenging due to different bleeding risks and may include laboratory testing, procedural delays, or haemostatic/reversal agent administration. We evaluated management strategies and outcomes of urgent, non-haemostatic invasive procedures in patients treated with DOACs. In a descriptive cohort study, we prospectively evaluated 478 patients in the GIHP-NACO registry, from June 2013 to November 2015. Hospitalised patients receiving dabigatran (n = 160), rivaroxaban (n = 274), or apixaban (n = 44) requiring urgent, procedural interventions were evaluated, of which 384/478 (80 %) were surgical procedures. Orthopaedic surgery included 216/384 patients (56 %), while gastrointestinal surgery included 75/384 (20 %) patients. On admission, the median age was 79 (70-85), and creatinine clearance was <60 mL·min In the GIHP-NACO registry, before specific antidotes were available, DOAC treated patients undergoing urgent invasive procedures were delayed in nearly half of the cases, and showed a low rate of excessive bleeding, suggesting that most urgent procedures can be performed safely without DOAC reversal. www. gov. Identifier: NCT02185027.
Sections du résumé
BACKGROUND
Patients treated with direct oral anticoagulants (DOACs) may require urgent procedures. Managing these patients is challenging due to different bleeding risks and may include laboratory testing, procedural delays, or haemostatic/reversal agent administration.
OBJECTIVE
We evaluated management strategies and outcomes of urgent, non-haemostatic invasive procedures in patients treated with DOACs.
METHODS AND RESULTS
In a descriptive cohort study, we prospectively evaluated 478 patients in the GIHP-NACO registry, from June 2013 to November 2015. Hospitalised patients receiving dabigatran (n = 160), rivaroxaban (n = 274), or apixaban (n = 44) requiring urgent, procedural interventions were evaluated, of which 384/478 (80 %) were surgical procedures. Orthopaedic surgery included 216/384 patients (56 %), while gastrointestinal surgery included 75/384 (20 %) patients. On admission, the median age was 79 (70-85), and creatinine clearance was <60 mL·min
CONCLUSIONS
In the GIHP-NACO registry, before specific antidotes were available, DOAC treated patients undergoing urgent invasive procedures were delayed in nearly half of the cases, and showed a low rate of excessive bleeding, suggesting that most urgent procedures can be performed safely without DOAC reversal.
CLINICAL TRIAL REGISTRATION
www.
CLINICALTRIALS
gov. Identifier: NCT02185027.
Identifiants
pubmed: 35785621
pii: S0049-3848(22)00298-5
doi: 10.1016/j.thromres.2022.06.005
pii:
doi:
Substances chimiques
Anticoagulants
0
Pyridones
0
Rivaroxaban
9NDF7JZ4M3
Dabigatran
I0VM4M70GC
Banques de données
ClinicalTrials.gov
['NCT02185027']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
106-112Informations de copyright
Copyright © 2022 Elsevier Ltd. All rights reserved.