Background Compliance with perioperative anticoagulation guidelines is essential to minimize bleeding and thromboembolic risks in patients undergoing surgery. Compared to vitamin-K antagonists (VKAs), perioperative management of direct oral anticoagulants (DOACs) contains fewer steps. Therefore, we hypothesized that noncompliance with guidelines in VKA users is higher than in DOAC users. The primary aim of our study was to investigate the difference in noncompliance to perioperative anticoagulant management guidelines between elderly patients using VKAs versus those using DOACs. The secondary aim was to determine the difference in occurrence of conflicting information communicated to the patients and the difference in incidence of coagulation-related adverse events. Methods This retrospective non-controlled observational cohort study examined elderly patients undergoing elective orthopedic surgery in a teaching hospital in the Netherlands. All patients undergoing elective orthopedic surgery between 1 May 2016 and 1 January 2020, aged 70 years and over, using VKAs or DOACs were selected. Nonelective surgeries were excluded. The primary outcome was the noncompliance to perioperative anticoagulant management guidelines. Secondary outcomes were missing or conflicting information on anticoagulation management communicated to the patient and coagulation-related adverse events. For continuous data, the unpaired T-test was used and for categorical data, the chi-square test. Results In patients using VKAs, noncompliance to one of the steps of perioperative anticoagulation management was 81%, compared to 55% in patients using DOACs (p < 0.001). In most cases, VKAs or DOACs were interrupted for longer than recommended. In 13% of patients using a VKA with perioperative bridging, bridging was not conducted as recommended in the guidelines. In 13% of patients using a DOAC, a low-molecular-weight heparin (LMWH) was prescribed while a DOAC had already been restarted postoperatively. VKA users received conflicting information about perioperative anticoagulation management more often than DOAC users (33% versus 20%; p < 0.001). No difference was seen in postoperative coagulation-related complications. Conclusion Guidelines compliance in DOAC users is higher than in VKA users. Clinical decision support to help in selecting the right interruption interval in DOAC users, simplified standardized perioperative management, good coordination of instructions given to patients, and familiarity with updated guidelines are important in reducing noncompliance.

Aim:To determine the prevalence and severity of respiratory and sleep disorders in the adult, indigenous remote communities of the Northern Territory. Method: Data was obtained from four remote communities visited by the Respiratory Outreach Clinic service from February 2010-October 2012. Data obtained included demographic characteristics, smoking status, diagnosis and investigation results. Results: 88 patients were reviewed during the above period. The age range was from 17-80 years, with a mean age of 55 years. 74% patients were either current or ex-smokers. 53/88 patients were diagnosed with COPD and 15/88 diagnosed with asthma. 7/88 patients had bronchiectasis alone and 22/88 patients were diagnosed with COPD and bronchiectasis. 6 patients were diagnosed with sleep disordered breathing. 52% of patients had documented chest x-ray findings and only 17% had documented CT chest results. 34/88 patients had documented spirometry results. Of the 53 patients with COPD, 19 had documented spirometry results and 74% were recorded as severe obstruction. 29 patients had undergone transthoracic echocardiogram and 12/29 showed evidence of pulmonary hypertension. Conclusion: Preliminary data from this audit indicates COPD and asthma are common respiratory conditions amongst the remote indigenous population. The prevalence of current and ex-smokers is also high. Our preliminary results show that access to investigations such as lung function testing and imaging is limited which is a significant barrier to identification of respiratory disorders and accurate diagnosis in this population. The complete set of data in all other communities visited by the Respiratory outreach service will be presented at the conference. TO 002 DON'T FORGET TO BREATHE: A RESOURCE FOR THOSE WITH COPD WARD S, DONNELLY C Hawkes Bay District Health BoardAim: To produce an evidence based e-book primarily for individuals with a diagnosis of COPD, or for those requiring further support and information on this chronic disease. This literature was to be readily available free of charge or at minimal cost. Methods: Content was agreed upon by the authors, the workload was divided with specialities delegated to colleagues. Google Docs was used as a live document between the authors with regular Skype meetings to discuss direction and time frame. Clients of the Hawkes Bay District health Board pulmonary rehabilitation group were selected to proof read as were colleagues. Results: Don't Forget to Breathe is now in its second edition, and is freely available via the website www.dontforgettobreathe.org.nz. It is published under a creative commons licence to enable people to copy and share the work as widely as possible.It has been downloaded in 32 countries globally. Each GP practice throughout Hawkes Bay has at least one copy to use as a teaching aid, as well as hospital wards and physiotherapy departments.A link is available on the following websites. www.hbdhb.govt.nz, www.cdhb.health.nz; www.healthnavigator.org.nz Permission has been requested from both US a...