DOAC Type, Dose Non-Consequential in Perioperative Bleeding Risk

July 17, 2019
Patients with atrial fibrillation (AF) receiving treatment with direct oral anticoagulants (DOACs) who find themselves in the common scenario of needing to interrupt the treatments for elective surgeries show no increased risk of major bleeding or arterial thromboembolism based on the type or dose of DOAC. “The perioperative management of patients with atrial fibrillation who are taking a direct oral anticoagulant and need elective surgery/procedure is a common problem for which management is uncertain,” explained James Douketis, MD, McMaster University, Hamilton, Ontario, and colleagues. For the PAUSE study, the researchers compared the 30-day postoperative rates of major bleeding, arterial thromboembolism, and residual preoperative DOAC levels among patients treated with apixaban (n = 1,257), dabigatran (n = 668), or rivaroxaban (n = 1,082). The results, presented at the 2019 Annual Meeting of the International Society on Thrombosis and Hemostasis (ISTH), showed that compared with apixaban-treated patients, there was no significant difference in major bleeding rates among dabigatran-treated patients (odds ratio [OR] = 0.66; 95% confidence interval [CI], 0.24-1.60) or rivaroxaban-treated patients (OR = 1.37; 95% CI, 0.72-2.67). In addition, there were and no significant difference in arterial thromboembolism rates, compared with apixaban, for the dabigatran group (OR = 3.78; 95% CI, 0.74-27.3) or the rivaroxaban group (OR = 2.33; 95% CI, 0.45-16.8). There were no significant differences in rates of major bleeding or arterial thromboembolism according to the dose of the DOACs. Compared with having no residual DOAC level (50 ng/mL) showed no significant effect on risk of major bleeding or arterial thromboembolism rates. “In patients with atrial fibrillation who require perioperative DOAC interruption for an elective surgery/procedure, the DOAC type and dose used, as well as residual DOAC levels, did not affect risks for perioperative major bleeding and arterial thromboembolism,” the authors concluded. Reference: SOURCE: ISTH 2019