Key result
Clinician-driven periprocedural edoxaban interruption is linked to <1% major bleeding risk across surgical types.
Why the study?
Optimising periprocedural management of DOACs in AF patients on chronic treatment undergoing major surgeries is important to balance surgery-related bleeding against thromboembolic risk, which may vary by surgery type.
Does clinician-driven periprocedural edoxaban interruption result in safe bleeding and thromboembolic outcomes in patients undergoing major versus nonmajor surgeries?
Observational (n=711)
Yes
Does clinician-driven periprocedural edoxaban interruption result in safe bleeding and thromboembolic outcomes in patients undergoing major versus nonmajor surgeries?
Absolute Event Rate: 0.4% vs 0.6%
Clinician-driven periprocedural edoxaban interruption is significantly longer for major versus nonmajor surgeries, resulting in low rates of bleeding and thromboembolic events in both groups.
Low bleeding rates support tailored edoxaban interruption; extends observational data but leaves open need for randomized confirmation.
BACKGROUND: Optimising periprocedural management of direct oral anticoagulation in patients with atrial fibrillation on chronic treatment undergoing major surgeries is an important aspect of balancing the risk of surgery-related bleeding with the risk of thromboembolic events, which may vary by surgery type. METHODS: This subanalysis of the prospective EMIT-AF/VTE programme assessed periprocedural-edoxaban management, according to physicians' decisions, and bleeding and thromboembolic event rates in patients who underwent major vs. nonmajor surgeries. Edoxaban interruption and clinical outcomes were compared between major vs. nonmajor surgeries and between renal function subgroups (creatinine clearance [CrCL] ≤ 50 mL/min vs. > 50 mL/min). RESULTS: We included 276 major and 512 nonmajor surgeries. The median pre- and postprocedural duration of edoxaban interruption in major vs. nonmajor surgeries was 4 vs. 1 days, whereas median duration of interruption for those with preprocedural-only and postprocedural-only interruption was 2 vs. 1 days and 2 vs. 0 days, respectively (P < 0.0001). Rates of all bleeding and clinically relevant nonmajor bleeding were numerically higher in major vs. nonmajor surgeries. Event rates (number of events per 100 surgeries) were low overall (< 6 events per 100 surgeries), independent of renal function subgroups. CONCLUSION: In this subanalysis of the EMIT-AF/VTE programme, periprocedural-edoxaban interruption was significantly longer in patients undergoing major vs. nonmajor surgery. This clinician-driven approach was associated with low rates of bleeding and thromboembolic events following both major and nonmajor surgeries. TRIAL REGISTRATION: NCT02950168, registered October 31, 2016; NCT02951039, registered November 1, 2016.
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Heymann et al. (2023) conducted an observational in Atrial fibrillation or venous thromboembolism undergoing surgery (n=711). Edoxaban (major surgery) vs. Edoxaban (nonmajor surgery) was evaluated on Incidence of major bleeding. Clinician-driven periprocedural edoxaban interruption was longer for major versus nonmajor surgeries and resulted in low rates of major bleeding (0.4 vs. 0.6 events per 100 surgeries) in both groups.
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