CC BY 4.0 · TH Open 2020; 04(02): e127-e137
DOI: 10.1055/s-0040-1712476
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

1  Anaesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, València, Spain
,
Juan V. Llau
2  Anaesthesiology and Critical Care, Hospital Universitario Doctor Peset, València, Spain
,
Javier F. Sanz
3  Anaesthesiology and Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
Concepción M. Cassinello
4  Anaesthesiology and Critical Care, Hospital Miguel Servet, Zaragoza, Spain
,
Óscar González-Larrocha
5  Anaesthesiology and Critical Care, Hospital Galdakao-Usánsolo, Bizkaia, Spain
,
Salomé M. Matoses
1  Anaesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, València, Spain
,
Vanessa Suárez
6  Anaesthesiology and Critical Care, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
,
Patricia Guilabert
7  Anaesthesiology and Critical Care, Hospital Universitari Vall d'Hebron, Barcelona, Spain
,
Luís-Miguel Torres
8  Anaesthesiology and Critical Care, Hospital Universitario Puerta del Mar, Cadiz, Spain
,
Esperanza Fernández-Bañuls
9  Anaesthesiology and Critical Care, Hospital Lluís Alcanyís, Xàtiva, Spain
,
Consuelo García-Cebrián
1  Anaesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, València, Spain
,
Pilar Sierra
10  Anaesthesiology and Critical Care, Fundació Puigvert, Barcelona, Spain
,
Marta Barquero
11  Anaesthesiology and Critical Care, Hospital Parc Taulí, Sabadell, Spain
,
Nuria Montón
1  Anaesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, València, Spain
,
Cristina Martínez-Escribano
12  Anaesthesiology and Critical Care, Hospital de La Ribera, Alzira, Spain
,
Manuel Llácer
13  Anaesthesiology and Critical Care, Hospital Costa del Sol, Marbella, Spain
,
Aurelio Gómez-Luque
14  Anaesthesiology and Critical Care, Hospital Universitario Virgen de la Victoria, Málaga, Spain
,
Julia Martín
2  Anaesthesiology and Critical Care, Hospital Universitario Doctor Peset, València, Spain
,
Francisco Hidalgo
15  Anaesthesiology and Critical Care, Clínica Universitaria de Navarra, Pamplona, Spain
,
Gabriel Yanes
16  Anaesthesiology and Critical Care, Hospital Virgen del Rocio, Sevilla, Spain
,
Rubén Rodríguez
17  Anaesthesiology and Critical Care, Hospital Universitario de Móstoles, Madrid, Spain
,
Beatriz Castaño
18  Anaesthesiology and Critical Care, Complejo Hospitalario de Toledo, Toledo, Spain
,
Elena Duro
19  Anaesthesiology and Critical Care, Hospital Universitario de Getafe, Madrid, Spain
,
Blanca Tapia
20  Anaesthesiology and Critical Care, Hospital La Paz, Madrid, Spain
,
Antoni Pérez
21  Anaesthesiology and Critical Care, Hospital de Mataró, Mataró, Spain
,
Ángeles M. Villanueva
22  Anaesthesiology and Critical Care, Hospital Universitario Marqués de Valdecilla, Santander, Spain
,
Juan-Carlos Álvarez
23  Anaesthesiology and Critical Care, Hospital Universitario Parc de Salut Mar, Barcelona, Spain
,
Sergi Sabaté
10  Anaesthesiology and Critical Care, Fundació Puigvert, Barcelona, Spain
,
for the RA-ACOD investigators› Author Affiliations
Funding This work was supported by a governmental grant from the Instituto de Salud Carlos III (PI13/02742).
Further Information

Publication History

28 December 2019

14 April 2020

Publication Date:
26 June 2020 (online)

Abstract

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.

Authors' Contributions

R.F. and J.V.L. contributed toward: (1) conception and design, acquisition of data, and analysis and interpretation of data; (2) drafting the article and revising it critically for important intellectual content; (3) final approval of the version to be published; (4) agreement to be accountable for all aspects of the work thereby ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. F.J.S., M.C.C., O.G.L., M.S.M., V.S., P.G., L.M.T., E.F.B., C.G.C., P.S., M.B., N.M., C.M.E., M.L., A.G.L., J.M., F.H., G.Y., R.R., B.C., E.D., B.T., A.P., M.A.V., J.C.A., and S.S. contributed toward: (1) acquisition of data; (2) revising the article critically for important intellectual content; (3) final approval of the version to be published; (4) agreement to be accountable for all aspects of the work thereby ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RA-ACOD investigators contributed toward: (1) acquisition of data; (2) final approval of the version to be published; (3) agreement to be accountable for all aspects of the work thereby ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


* A complete list of the RA-ACOD investigators is provided as [Supplementary Appendix].


Supplementary Material