Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry
Raquel Ferrandis 1 , Juan V Llau 2 , Javier F Sanz 3 , Concepción M Cassinello 4 , Óscar González-Larrocha 5 , Salomé M Matoses 1 , Vanessa Suárez 6 , Patricia Guilabert 7 , Luís-Miguel Torres 8 , Esperanza Fernández-Bañuls 9 , Consuelo García-Cebrián 1 , Pilar Sierra 10 , Marta Barquero 11 , Nuria Montón 1 , Cristina Martínez-Escribano 12 , Manuel Llácer 13 , Aurelio Gómez-Luque 14 , Julia Martín 2 , Francisco Hidalgo 15 , Gabriel Yanes 16 , Rubén Rodríguez 17 , Beatriz Castaño 18 , Elena Duro 19 , Blanca Tapia 20 , Antoni Pérez 21 , Ángeles M Villanueva 22 , Juan-Carlos Álvarez 23 , Sergi Sabaté 10 , RA-ACOD investigators
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.
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]).
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.
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.
CITA DEL ARTÍCULO TH Open. 2020 Jun 26;4(2):e127-e137.