title: Perioperative bridging anticoagulation during dabigatran or warfarin interruption among patients who had an elective surgery or procedure. Substudy of the RE-LY trial.
abstract: In patients with atrial fibrillation (AF) who require interruption of dabigatran or warfarin for an elective surgery/procedure, the risks and benefits of perioperative bridging anticoagulation is uncertain.We accessed the database from RE-LY, a randomised trial comparing dabigatran with warfarin for stroke prevention in AF, to assess the potential benefits and risks of bridging. In patients who had a first interruption of dabigatran or warfarin for an elective surgery/procedure, we compared the risk for major bleeding (MB), stroke or systemic embolism (SSE) and any thromboembolism (TE) in patients who were bridged or not bridged during the period of seven days before until 30 days after surgery/procedure. We used multivariable Cox regression to adjust for potential confounders.Bridging was used more during warfarin interruption than dabigatran interruption (27.5 % vs 15.4 %; p< 0.001). With dabigatran interruption, bridged patients had more MB (6.5 % vs 1.8 %, p< 0.001) than those not bridged but bridged and not bridged groups did not differ for any TE (1.2 % vs 0.6 %, p=0.16) and SSE (0.5 % vs 0.3 %, p=0.46). With warfarin interruption, bridged patients had more MB (6.8 % vs 1.6 %, p< 0.001) and any TE (1.8 % vs 0.3 %, p=0.007) than those not bridged but bridged and not bridged groups did not differ for SSE (0.5 % vs 0.2 %, p=0.321). In conclusion, in patients who interrupted dabigatran or warfarin for a surgery/ procedure in the RE-LY trial, use of bridging anticoagulation appeared to increase the risk for major bleeding irrespective of dabigatran or warfarin interruption.
authors.affiliation: Dr. James D. Douketis, St. Joseph's Healthcare Hamilton, Room F-544, 50 Charlton Ave. East, Hamilton, ON, Canada, L8N 4A6, E-mail: jdouket@mcmaster.ca.
authors.forename: James D
authors.initials: JD
authors.lastname: Douketis
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Healey
authors.forename: Martina
authors.initials: M
authors.lastname: Brueckmann
authors.forename: John W
authors.initials: JW
authors.lastname: Eikelboom
authors.forename: Michael D
authors.initials: MD
authors.lastname: Ezekowitz
authors.forename: Mandy
authors.initials: M
authors.lastname: Fraessdorf
authors.forename: Herbert
authors.initials: H
authors.lastname: Noack
authors.forename: Jonas
authors.initials: J
authors.lastname: Oldgren
authors.forename: Paul
authors.initials: P
authors.lastname: Reilly
authors.forename: Alex C
authors.initials: AC
authors.lastname: Spyropoulos
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Connolly
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D000069604:Dabigatran / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D057216:Propensity Score; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069604:Dabigatran
keywords: Bridging anticoagulation; dabigatran; surgery; warfarin