Management of urgent invasive procedures in patients treated with direct oral anticoagulants: An observational registry analysis.

Journal Article (Journal Article)

BACKGROUND: Patients treated with direct oral anticoagulants (DOACs) may require urgent procedures. Managing these patients is challenging due to different bleeding risks and may include laboratory testing, procedural delays, or haemostatic/reversal agent administration. OBJECTIVE: We evaluated management strategies and outcomes of urgent, non-haemostatic invasive procedures in patients treated with DOACs. METHODS AND RESULTS: In a descriptive cohort study, we prospectively evaluated 478 patients in the GIHP-NACO registry, from June 2013 to November 2015. Hospitalised patients receiving dabigatran (n = 160), rivaroxaban (n = 274), or apixaban (n = 44) requiring urgent, procedural interventions were evaluated, of which 384/478 (80 %) were surgical procedures. Orthopaedic surgery included 216/384 patients (56 %), while gastrointestinal surgery included 75/384 (20 %) patients. On admission, the median age was 79 (70-85), and creatinine clearance was <60 mL·min-1 in 316/478 (66 %) patients. DOAC concentration was determined in 277 (58 %) patients and was 85 ng·mL-1 (median; range 0-764), 61 ng·mL-1 (3-541), and 81 ng·mL-1 (26-354) for dabigatran, rivaroxaban, and apixaban, respectively. Procedures were delayed in 194/455 (43 %) of the cases. Excessive bleeding was observed in 62/478 (13 %) procedures, and haemostatic agents were administered in 76/478 (16 %) procedures. By day 30, major cerebral and cardiovascular events were observed in 38/478 (7.9 %) patients, and mortality was 28/478 (5.9 %). CONCLUSIONS: In the GIHP-NACO registry, before specific antidotes were available, DOAC treated patients undergoing urgent invasive procedures were delayed in nearly half of the cases, and showed a low rate of excessive bleeding, suggesting that most urgent procedures can be performed safely without DOAC reversal. CLINICAL TRIAL REGISTRATION: www. CLINICALTRIALS: gov. Identifier: NCT02185027.

Full Text

Duke Authors

Cited Authors

  • Godon, A; Gabin, M; Levy, JH; Huet, O; Chapalain, X; David, J-S; Tacquard, C; Sattler, L; Minville, V; Mémier, V; Blanié, A; Godet, T; Leone, M; De Maistre, E; Gruel, Y; Roullet, S; Vermorel, C; Samama, CM; Bosson, J-L; Albaladejo, P; GIHP-NACO Study Group,

Published Date

  • August 2022

Published In

Volume / Issue

  • 216 /

Start / End Page

  • 106 - 112

PubMed ID

  • 35785621

Electronic International Standard Serial Number (EISSN)

  • 1879-2472

Digital Object Identifier (DOI)

  • 10.1016/j.thromres.2022.06.005


  • eng

Conference Location

  • United States