Key result
Discontinuation of oral antithrombotic agents during medical procedures was associated with higher rates of thromboembolic events (1.7% vs 0.6%, P<0.001) and major bleeding (7.6% vs 0.4%, P<0.001).
Why the study?
Optimal management of antithrombotic agents during surgery has yet to be established.
Does discontinuation of oral antithrombotic agents compared to continuation affect the risk of thromboembolic events, bleeding, and death in patients undergoing scheduled medical procedures?
Observational (n=9,700)
Yes
Does discontinuation of oral antithrombotic agents compared to continuation affect the risk of thromboembolic events, bleeding, and death in patients undergoing scheduled medical procedures?
Absolute Event Rate: 1.7% vs 0.6%
p-value: p=<0.001
In patients undergoing scheduled procedures, discontinuing oral antithrombotics and using heparin bridging are associated with higher risks of thromboembolic and bleeding events compared to continuing oral antithrombotics.
May support continuing oral antithrombotics periprocedurally; leaves open need for randomized trials.
Background Optimal management of antithrombotic agents during surgery has yet to be established. We performed a prospective multicenter observational study to determine the current status of the management of antithrombotic agents during surgery or other medical procedures with bleeding (MARK [Management of Antithrombotic Agents During Surgery or Other Kinds of Medical Procedures With Bleeding] study) in Japan. Methods and Results The participants were 9700 patients who received oral antithrombotic agents and underwent scheduled medical procedures with bleeding at 59 National Hospital Organization institutions in Japan. Primary outcomes were thromboembolic events, bleeding events, and death within 2 weeks before and 4 weeks after the procedures. We investigated the relationships between each outcome and patient demographics, comorbidities, type of procedure, and management of antithrombotic therapy. With respect to the periprocedural management of antithrombotic agents, 3551 patients continued oral antithrombotic agents (36.6%, continuation group) and 6149 patients discontinued them (63.4%, discontinuation group). The incidence of any thromboembolic event (1.7% versus 0.6%, P <0.001), major bleeding (7.6% versus 0.4%, P <0.001), and death (0.8% versus 0.4%, P <0.001) was all greater in the discontinuation group than the continuation group. In multivariate analysis, even after adjusting for confounding factors, discontinuation of anticoagulant agents was significantly associated with higher risk for both thromboembolic events (odds ratio: 4.55; 95% CI, 1.67–12.4; P =0.003) and major bleeding (odds ratio: 11.1; 95% CI, 2.03–60.3; P =0.006) in procedures with low bleeding risk. In contrast, heparin bridging therapy was significantly associated with higher risk for both thromboembolic events (odds ratio: 2.03; 95% CI, 1.28–3.22; P =0.003) and major bleeding (odds ratio: 1.36; 95% CI, 1.10–1.68; P =0.005) in procedures with high bleeding risk. Conclusions Discontinuation of oral antithrombotic agents and addition of low‐dose heparin bridging therapy appear to be significantly associated with adverse events in the periprocedural period.
No takes yet. Share an insight, caveat, or question.
Gotoh et al. (2020) conducted an observational in Patients receiving oral antithrombotic agents undergoing scheduled medical procedures with bleeding (n=9,700). Discontinuation of oral antithrombotic agents vs. Continuation of oral antithrombotic agents was evaluated on Any thromboembolic event within 2 weeks before and 4 weeks after the procedures (p=<0.001). Discontinuation of oral antithrombotic agents during medical procedures was associated with higher rates of thromboembolic events (1.7% vs 0.6%, P<0.001) and major bleeding (7.6% vs 0.4%, P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: