A standardized periprocedural DOAC interruption strategy for elective digestive endoscopy in AF patients resulted in low 30-day rates of arterial thromboembolism (0.7%) and major GI bleeding (0.9%).
Cohort (n=556)
Does a standardized periprocedural DOAC management strategy prevent bleeding and thromboembolic events in patients with atrial fibrillation undergoing elective digestive endoscopy?
A standardized periprocedural DOAC interruption strategy for elective digestive endoscopy in patients with AF is associated with low rates of arterial thromboembolism and major bleeding.
INTRODUCTION: The periprocedural management of patients with atrial fibrillation (AF) using a direct oral anticoagulant (DOAC) undergoing elective gastrointestinal (GI) endoscopic procedure remains uncertain. We investigated the safety of a standardized periprocedural DOAC management strategy. METHODS: The Periprocedural Anticoagulation Use for Surgery Evaluation cohort study enrolled adult patients receiving a DOAC (apixaban, rivaroxaban, or dabigatran) for AF scheduled for an elective procedure or surgery. This analysis addresses patients undergoing digestive endoscopy. Standardized periprocedural management consisted of DOAC interruption 1 day preendoscopy with resumption 1 day after procedure at low-moderate risk of bleeding or 2 days in case of a high bleeding risk. Thirty-day outcomes included GI bleeding, thromboembolic events, and mortality. RESULTS: Of 556 patients on a DOAC (mean SD age of 72.5 8.6 years; 37.4% female; mean CHADS 2 score 1.7 1.0), 8.6% were also on American Society of Anesthesiology (ASA) and 0.7% on clopidogrel. Most of the patients underwent colonoscopies (63.3%) or gastroscopies (14.0%), with 18.9% having both on the same procedural day. The mean total duration of DOAC interruption was 3.9 ± 1.6 days. Four patients experienced an arterial thromboembolic event (0.7%, 0.3%-1.8%) within 24.2 ± 5.9 days of DOAC interruption. GI bleeding events occurred in 2.5% (1.4%-4.2%) within 11.1 ± 8.1 days (range: 0.6; 25.5 days) of endoscopy, with major GI bleeding in 0.9% (0.4%-2.1%). Three patients died (0.5%; 0.2%-1.6%) 15.6-22.3 days after the endoscopy. DISCUSSION: After a contemporary standardized periprocedural management strategy, patients with AF undergoing DOAC therapy interruption for elective digestive endoscopy experienced low rates of arterial thromboembolism and major bleeding.
Hansen-Barkun et al. (Sat,) conducted a cohort in Atrial fibrillation (n=556). Standardized periprocedural DOAC management strategy was evaluated on 30-day arterial thromboembolic events (95% CI 0.3-1.8). A standardized periprocedural DOAC interruption strategy for elective digestive endoscopy in AF patients resulted in low 30-day rates of arterial thromboembolism (0.7%) and major GI bleeding (0.9%).