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In this retrospective, single-centre, observational study, we assessed (i) use of anticoagulant and antiplatelet (AP) therapy, (ii) the duration of direct-acting oral anticoagulant (DOAC) discontinuation, (iii) renal function and (iv) PT and APTT as predictors of bleeding and blood product usage; in adults (>18 years) undergoing major cardiac surgery from 01.01.2015 to 31.12.2018. Comparisons were made between each treatment group (warfarin, DOAC and DOAC + AP) and untreated controls, and between warfarin and DOAC. A total of 2928 patients were included for analysis. Median (range) of DOAC discontinuation prior to surgery was five days (1-22) for DOAC and five days (2-7) for DOAC + AP. There were no differences in bleeding between anticoagulant groups versus control, or DOAC versus warfarin. There were no differences in blood product use between DOAC and warfarin patients. The duration of DOAC discontinuation but not the creatinine clearance influenced bleeding and blood products use. Thrombosis occurred in 0·7% and 3·1% in controls and patients on warfarin respectively (P = 0·099) with none among patients on DOAC or DOAC + AP. The PT/APTT had no predictive value. Median five-day discontinuation of DOAC +/- AP irrespective of renal function prevents an increase in bleeding compared to patients on warfarin or controls with no increase in thrombosis.

Titel:	Effect of direct-acting oral anticoagulants (DOACs) on bleeding and blood product usage in cardiac surgery compared to warfarin and controls.
Autor/in / Beteiligte Person:	Little, C ; Szydlo, R ; Aw, TC ; Laffan, M ; Arachchillage, DRJ
Link:	Zum Volltext
Zeitschrift:	British journal of haematology, Jg. 190 (2020-07-01), Heft 2, S. 284-293
Veröffentlichung:	Oxford : Wiley-Blackwell ; <i>Original Publication</i>: Oxford : Blackwell Scientific Publications, 2020
Medientyp:	academicJournal
ISSN:	1365-2141 (electronic)
DOI:	10.1111/bjh.16521
Schlagwort:	Adolescent Adult Aged Aged, 80 and over Anticoagulants pharmacology Female Humans Male Middle Aged Retrospective Studies Warfarin pharmacology Young Adult Anticoagulants therapeutic use Cardiac Surgical Procedures methods Hemorrhage chemically induced Warfarin therapeutic use
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Br J Haematol] 2020 Jul; Vol. 190 (2), pp. 284-293. <i>Date of Electronic Publication: </i>2020 Mar 03. MeSH Terms: Anticoagulants / therapeutic use ; Cardiac Surgical Procedures / methods ; Hemorrhage / chemically induced ; Warfarin / therapeutic use ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants / pharmacology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Warfarin / pharmacology ; Young Adult References: Abdul-Jawad Altisent, O., Durand, E., Muñoz-García, A.J., Nombela-Franco, L., Cheema, A., Kefer, J., Gutierrez, E., Benítez, L.M., Amat-Santos, I.J., Serra, V., Eltchaninoff, H., Alnasser, S.M., Elízaga, J., Dager, A., García del Blanco, B., Ortas-Nadal, M. del R., Marsal, J.R., Campelo-Parada, F., Regueiro, A., Del Trigo, M., Dumont, E., Puri, R. & Rodés-Cabau, J. 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Journal of Interventional Cardiac Electrophysiology, 48, 267-282. Contributed Indexing: Keywords: bleeding; cardiac surgery; direct-acting oral anticoagulant; thrombosis; warfarin Substance Nomenclature: 0 (Anticoagulants) ; 5Q7ZVV76EI (Warfarin) Entry Date(s): Date Created: 20200305 Date Completed: 20210302 Latest Revision: 20210302 Update Code: 20231215

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Effect of direct-acting oral anticoagulants (DOACs) on bleeding and blood product usage in cardiac surgery compared to warfarin and controls.