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

Publication ,  Journal Article
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 ...
Published in: Thromb Res
August 2022

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.

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Published In

Thromb Res

DOI

EISSN

1879-2472

Publication Date

August 2022

Volume

216

Start / End Page

106 / 112

Location

United States

Related Subject Headings

  • Rivaroxaban
  • Registries
  • Pyridones
  • Humans
  • Hemorrhage
  • Dabigatran
  • Cohort Studies
  • Cardiovascular System & Hematology
  • Anticoagulants
  • Aged
 

Citation

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Godon, A., Gabin, M., Levy, J. H., Huet, O., Chapalain, X., David, J.-S., … GIHP-NACO Study Group, . (2022). Management of urgent invasive procedures in patients treated with direct oral anticoagulants: An observational registry analysis. Thromb Res, 216, 106–112. https://doi.org/10.1016/j.thromres.2022.06.005
Godon, Alexandre, Manon Gabin, Jerrold H. Levy, Olivier Huet, Xavier Chapalain, Jean-Stéphane David, Charles Tacquard, et al. “Management of urgent invasive procedures in patients treated with direct oral anticoagulants: An observational registry analysis.Thromb Res 216 (August 2022): 106–12. https://doi.org/10.1016/j.thromres.2022.06.005.
Godon A, Gabin M, Levy JH, Huet O, Chapalain X, David J-S, et al. Management of urgent invasive procedures in patients treated with direct oral anticoagulants: An observational registry analysis. Thromb Res. 2022 Aug;216:106–12.
Godon, Alexandre, et al. “Management of urgent invasive procedures in patients treated with direct oral anticoagulants: An observational registry analysis.Thromb Res, vol. 216, Aug. 2022, pp. 106–12. Pubmed, doi:10.1016/j.thromres.2022.06.005.
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. Management of urgent invasive procedures in patients treated with direct oral anticoagulants: An observational registry analysis. Thromb Res. 2022 Aug;216:106–112.
Journal cover image

Published In

Thromb Res

DOI

EISSN

1879-2472

Publication Date

August 2022

Volume

216

Start / End Page

106 / 112

Location

United States

Related Subject Headings

  • Rivaroxaban
  • Registries
  • Pyridones
  • Humans
  • Hemorrhage
  • Dabigatran
  • Cohort Studies
  • Cardiovascular System & Hematology
  • Anticoagulants
  • Aged