Publicaciones científicas

Periprocedural Direct Oral Anticoagulant Management: The RA-ACOD Prospective, Multicenter Real-World Registry

26-jun-2020 | Revista: TH Open

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


Introduction
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.

Methods
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]).

Results
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.

Conclusion
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.
doi: 10.1055/s-0040-1712476