Key result
Heparin bridging during DOAC interruption linked to ~12-fold higher major postoperative bleeding risk.
Why the study?
The effect of perioperative management of direct oral anticoagulants on bleeding and thromboembolic complications during gastroenterological surgery was investigated.
Does perioperative DOAC interruption without heparin bridging reduce bleeding complications compared to heparin bridging or warfarin in patients undergoing elective gastroenterological surgery?
Population
334 patients receiving anticoagulants and undergoing elective GE surgery between 2012 and 2018
Comparison
Warfarin vs DOAC with heparin bridging vs DOAC without heparin bridging
Design
Cohort study
Authors
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Heparin bridging was associated with higher bleeding risk in this cohort; leaves open optimal periprocedural DOAC management in elective gastroenterological surgery.
Cohort (n=334)
Does perioperative DOAC interruption without heparin bridging reduce bleeding complications compared to heparin bridging or warfarin in patients undergoing elective gastroenterological surgery?
Effect estimate: OR 11.60
Absolute Event Rate: 14.7% vs 1.4%
p-value: p=0.028
Perioperative heparin bridging during DOAC interruption for elective gastroenterological surgery significantly increases the risk of major postoperative bleeding without reducing thromboembolic events, and should not be recommended.
Fujikawa et al. (2020) conducted a cohort in Patients receiving anticoagulants undergoing elective gastroenterological surgery (n=334). DOAC with heparin bridging vs. DOAC without heparin bridging or warfarin was evaluated on Major postoperative bleeding (OR 11.60, p=0.028). Perioperative heparin bridging during DOAC interruption for elective gastroenterological surgery significantly increased the risk of major postoperative bleeding (OR 11.60, P=0.028).
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