title: Thrombotic and bleeding outcomes following perioperative interruption of direct oral anticoagulants in patients with venous thromboembolic disease.
abstract: Essentials Studies evaluating the procedural interruption of direct oral anticoagulants (DOACs) are lacking. We conducted a study of the interruption of DOACs for prior venous thromboembolic disease (VTE). The post-operative risks of recurrent VTE and major bleeding are low in this patient population. A scheme based on half-life and procedure-related bleeding appears safe and efficacious.
  
  
  
  Background Direct oral anticoagulants (DOACs) are increasingly being used in the setting of venous thromboembolic disease (VTE). There is little evidence to guide the peri-procedural interruption of DOACs in this patient population. A number of studies have evaluated the perioperative interruption of DOACs based on half-life of the anticoagulant and the underlying procedural bleeding risk in patient with atrial fibrillation, but it remains unclear whether these findings can be extended to patients with VTE. Objective Evaluate thrombotic and bleeding outcomes following the perioperative interruption of direct oral anticoagulation in patients with prior VTE. Methods We conducted a retrospective analysis of consecutive patients on a DOAC for prior VTE requiring temporary interruption of anticoagulation for an invasive procedure. The primary efficacy outcome was the 30-day symptomatic VTE rate, and the primary safety outcome was the 30-day major bleeding rate. Secondary outcomes included overall mortality and the rate of clinically relevant non-major bleeding. Results A total of 190 patients were included in the analysis. The 30-day VTE rate was 1.05% (95% CI, 0.29-3.8%) and the 30-day major bleeding rate was 0.53% (95% CI, 0.09-2.93%). There were no deaths during the 30-day follow-up period. The rate of clinically relevant non-major bleeding was 3.16% (95%CI , 1.46-6.72%). Conclusions The perioperative interruption of DOACs in the setting of VTE, using a strategy that considers the half-life of the DOAC and the underlying procedural bleeding risk, appears to be both safe and effective.
authors.affiliation: Department of Medicine, Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada.|Ottawa Hospital Research Institute, Ottawa, ON, Canada.|Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Shaw
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: C
authors.initials: C
authors.lastname: de Wit
authors.affiliation: Department of Medicine, Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada.|Ottawa Hospital Research Institute, Ottawa, ON, Canada.|Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Le Gal
authors.affiliation: Department of Medicine, Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada.|Ottawa Hospital Research Institute, Ottawa, ON, Canada.|Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Carrier
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D001777:Blood Coagulation / Q000187:drug effects*; D000069604:Dabigatran / Q000008:administration & dosage; D004334:Drug Administration Schedule; D065427:Factor Xa Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D005260:Female; D006207:Half-Life; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D011720:Pyrazoles / Q000008:administration & dosage; D011728:Pyridones / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000069552:Rivaroxaban / Q000008:administration & dosage; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000991:Antithrombins; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: anticoagulants; hemorrhage; surgery; venous thromboembolism; venous thrombosis