Key result
In patients presenting with emergencies, specific plasma DOAC levels were measured significantly less frequently than INR for VKA patients (33.1% vs 97.6%), and had a poor relationship with hemostatic agent administration.
Why the study?
Restoring hemostasis in patients on oral anticoagulants presenting with major hemorrhage or before surgery has changed with DOACs replacing VKAs, warranting observation of differences in urgent hemostatic management.
Does management and clinical outcome differ between patients on DOACs versus VKAs presenting with major hemorrhage or requiring urgent surgery?
Observational (n=1,194)
Yes
Does management and clinical outcome differ between patients on DOACs versus VKAs presenting with major hemorrhage or requiring urgent surgery?
Despite less frequent laboratory monitoring and reversal agent administration, patients on DOACs have similar mortality and length of stay compared to those on VKAs following major hemorrhage or urgent surgery.
Infrequent DOAC level testing and reversal use in emergencies was associated with similar outcomes to VKAs; leaves open whether routine testing improves management.
Background: Restoring hemostasis in patients on oral anticoagulants presenting with major hemorrhage (MH) or before surgical intervention has changed, with the replacement of vitamin K antagonist (VKA) with direct oral anticoagulants (DOACs). Objectives: To observe the difference in urgent hemostatic management between patients on VKA and those on DOACs. Methods: A multicenter observational study evaluated the variation in laboratory testing, hemostatic management, mortality, and hospital length of stay (LOS) in patients on VKA or DOACs presenting with MH or urgent hemostatic restoration. Results: Of the 1194 patients analyzed, 783 had MH (61% VKA) and 411 required urgent hemostatic restoration before surgery (56% VKA). Compared to the international normalized ratio (97.6%), plasma DOAC levels were measured less frequently (<45%), and the time taken from admission for the coagulation sample to reach the laboratory varied widely (median, 52.3 minutes; IQR, 24.8-206.7). No significant plasma DOAC level (<50 ng/mL) was found in up to 19% of patients. There was a poor relationship between plasma DOAC level and the usage of a hemostatic agent. When compared with patients receiving VKA (96.5%) or dabigatran (93.7%), fewer patients prescribed a factor Xa inhibitor (75.5%) received a prohemostatic reversal agent. The overall 30-day mortality for MH (mean: 17.8%) and length of stay (LOS) (median: 8.7 days) was similar between VKA and DOAC patients. Conclusion: In DOAC patients, when compared to those receiving VKA, plasma DOAC levels were measured less frequently than the international normalized ratio and had a poor relationship with administering a hemostatic reversal agent. In addition, following MH, mortality and LOS were similar between VKA and DOAC patients.
No takes yet. Share an insight, caveat, or question.
Baker et al. (2023) conducted an observational in Major hemorrhage or urgent hemostatic restoration (n=1,194). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Specific coagulation test performed for the type of oral anticoagulant (p=<0.0001). In patients presenting with emergencies, specific plasma DOAC levels were measured significantly less frequently than INR for VKA patients (33.1% vs 97.6%), and had a poor relationship with hemostatic agent administration.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: