title: Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry.
abstract: OBJECTIVE
  Patients receiving novel oral anticoagulants (NOACs) frequently undergo interventional procedures. Short half-lives and rapid onset of action allow for short periods of NOAC interruption without heparin bridging. However, outcome data for this approach are lacking. We evaluated the peri-interventional NOAC management in unselected patients from daily care.
  
  
  RESULTS
  Effectiveness and safety data were collected from an ongoing, prospective, non-interventional registry of >2100 NOAC patients. Outcome events were adjudicated using standard event definitions. Of 2179 registered patients, 595 (27.3%) underwent 863 procedures (15.6% minimal, 74.3% minor, and 10.1% major procedures). Until Day 30 ± 5 post-procedure, major cardiovascular events occurred in 1.0% of patients [95% confidence interval (95% CI) 0.5-2.0] and major bleeding complications in 1.2% (95% CI 0.6-2.1). Cardiovascular and major bleeding complications were highest after major procedures (4.6 and 8.0%, respectively). Heparin bridging did not reduce cardiovascular events, but led to significantly higher rates of major bleeding complications (2.7%; 95% CI 1.1-5.5) compared with no bridging (0.5%; 0.1-1.4; P = 0.010). Multivariate analysis demonstrated diabetes [odds ratio (OR) 13.2] and major procedures (OR 7.3) as independent risk factors for cardiovascular events. Major procedures (OR 16.8) were an independent risk factor for major bleeding complications. However, if major and non-major procedures were separately assessed, heparin bridging was not an independent risk factor for major bleeding.
  
  
  CONCLUSIONS
  Continuation or short-term interruption of NOAC is safe strategies for most invasive procedures. Patients at cardiovascular risk undergoing major procedures may benefit from heparin bridging, but bleeding risks need to be considered.
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Fetscherstrasse 74, 01307 Dresden, Germany jan.beyer@uniklinikum-dresden.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Beyer-Westendorf
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Gelbricht
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
authors.forename: Kati
authors.initials: K
authors.lastname: Förster
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Ebertz
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Köhler
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Werth
authors.affiliation: Institute for Medical Informatics and Biometry, Technical University Dresden, Dresden, Germany.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Kuhlisch
authors.affiliation: Institute for Medical Informatics and Biometry, Technical University Dresden, Dresden, Germany.
authors.forename: Thoralf
authors.initials: T
authors.lastname: Stange
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Thieme
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Daschkow
authors.affiliation: Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Weiss
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D065427:Factor Xa Inhibitors / Q000008:administration & dosage; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D006493:Heparin
keywords: Apixaban; Bridging; Dabigatran; Invasive procedures; Oral anticoagulants; Rivaroxaban