Bleeding Complications After Use of Novel Oral Anticoagulants in Patients Undergoing Cardiac Surgery

Hassan, Kambiz; Bayer, N.; Schlingloff, Friederike; Oberhoffer, Martin; Wohlmuth, Peter; Schmoeckel, Michael; Geidel, Stephan

doi:10.1016/j.athoracsur.2017.11.066

Cited by 32 publications

(22 citation statements)

References 16 publications

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“…A German study of 81 consecutive patients undergoing open-heart surgery recently described effects of the DOAC withdrawal interval on postoperative bleeding, re-thoracotomy and intensive care unit stay, and recommended a need for up to 10 days withdrawal prior to cardiac surgery, in particular for patients with reduced renal function. 7 In patients using rivaroxaban or ticagrelor, the same group has also described promising effects of CytoSorb®, a whole blood adsorber for extracorporeal purification of blood that may be used with a heart-lung machine during cardiac surgery. 10 In another recent German study, warfarin use in patients surviving acute type A aortic dissection was not related to late mortality or aortic growth.…”

Section: Survival Analysesmentioning

confidence: 99%

Operative survival in patients with acute aortic disease in the era of newer oral anticoagulants

Bjørnstad¹,

Khan

Røed-Undlien

et al. 2020

Open Heart

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AimsThe aim of this study was the analysis of the risk associated with direct oral anticoagulants (DOACs) in patients undergoing non-elective operations on the proximal aorta due to aortic disease.Methods and resultsData from the department’s register of cardiac surgery was analysed retrospectively with emphasis on operative mortality. 135 non-elective operations for proximal aortic disease (October 2016 to 2018) were identified, of which 19 died during the first 90 days. DOAC use was the top-ranked risk factor in the univariate analysis with a HR of 9.6 (3.1 to 29), p=0.00007. Using a Cox proportional hazards model including the most relevant risk factors, the risk associated with DOAC use remained significant with a HR of 6.1 (1.4 to 26.3), p=0.015. We did not find increased risk associated with warfarin use.ConclusionIn patients undergoing non-elective operations on the proximal aorta due to aortic disease, the use of DOAC is associated with increased operative mortality.

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Section: Survival Analysesmentioning

confidence: 99%

Operative survival in patients with acute aortic disease in the era of newer oral anticoagulants

Bjørnstad¹,

Khan

Røed-Undlien

et al. 2020

Open Heart

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“…One prospective study regarding peri‐operative management of dabigatran has been published; however, this did not include cardiac surgical patients . A recently published case series reported a trend towards higher chest drain losses in patients treated with dabigatran compared with rivaroxaban and apixaban, with a median of 3 days of withdrawal before surgery . Due to its renal elimination, patients with chronic kidney disease scheduled for cardiac surgery may require longer withdrawal times.…”

Section: Overview Of Doacs In Cardiac Surgerymentioning

confidence: 99%

International consensus statement on the peri‐operative management of direct oral anticoagulants in cardiac surgery

et al. 2018

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Despite current recommendations on the management of severe peri-operative bleeding, there is no pragmatic guidance for the peri-operative monitoring and management of cardiac surgical patients taking direct oral anticoagulants. Members of the Transfusion and Haemostasis Subcommittee of the European Association of Cardiothoracic Anaesthesiology, of their own volition, performed an independent systematic review of peerreviewed original research, review articles and case reports and developed the following consensus statement. This has been endorsed by the European Association of Cardiothoracic Anaesthesiology. In our opinion, most patients on direct oral anticoagulant therapy presenting for elective cardiac surgery can be safely managed in the peri-operative period if the following conditions are fulfilled: direct oral anticoagulants have been discontinued two days before cardiac surgery, corresponding to five elimination half-live periods; in patients with renal or hepatic impairment or a high risk of bleeding, a pre-operative plasma level of direct oral anticoagulants has been determined and found to be below 30 ng.ml À1 (currently only valid for dabigatran, rivaroxaban and apixaban). In cases where plasma level monitoring is not possible (e.g. assay was not available), discontinuation for 10 elimination half-live periods (four days) is required. For FXa inhibitors, a standard heparin-calibrated anti-Xa level of < 0.1 IU.ml À1 should be measured, indicating sufficient reduction in the anticoagulant effect. Finally, short-term bridging with heparin is not required in the pre-operative period.

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“…У ретроспективному дослідженні за участю 81 пацієнта перед операцією на відкритому серці, з яких 37 отримували ривароксабан, 35 -апіксабан та 9 -дабігатран, у пацієнтів з нирковою недостатністю тривалість перебування у відділенні реанімації була більшою, якщо НОАК був відмінений менше ніж за 10 діб до втручання [19]. Тому при нирковій недостатності деякі експерти рекомендують збільшити термін призупинення терапії цими препаратами у випадку планового оперативного втручання до 10 діб [47].…”

Section: пероральні антикоагулянтиunclassified

Medical treatment of patients before surgical myocardial revascularization

Shklianka¹,

Zharinov²,

Yepanchintseva³

et al. 2019

CSIC

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2 Національна медична академія післядипломної освіти імені П.Л. Шупика, Київ Медикаментозна підготовка пацієнтів до хірургічної реваскуляризації міокарда В огляді узагальнено сучасні дані щодо медикаментозної підготовки пацієнтів з ішемічною хворобою серця до планового шунтування вінцевих артерій. Проаналізовано специфіку передопераційного застосування окремих засобів серцево-судинної фармакотерапії порівняно з базисним лікуванням стабільної ішемічної хвороби серця. Зроблено акцент на термінах призупинення прийому антикоагулянтів та антитромбоцитарних засобів для зменшення частоти виникнення післяопераційних ускладнень, зокрема, кровотеч. Наведено дані щодо ефективності призначення в періопераційний період статинів у високих дозах для зниження випадків виникнення післяопераційної фібриляції передсердь. З позицій доказової медицини показано, що базисними засобами профілактики післяопераційних аритмій серця залишаються β-адреноблокатори, а в окремих випадках можна розглядати доцільність застосування аміодарону. Ключові слова: шунтування вінцевих артерій, медикаментозне лікування, ішемічна хвороба серця.

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Bleeding Complications After Use of Novel Oral Anticoagulants in Patients Undergoing Cardiac Surgery

Cited by 32 publications

References 16 publications

Operative survival in patients with acute aortic disease in the era of newer oral anticoagulants

Operative survival in patients with acute aortic disease in the era of newer oral anticoagulants

International consensus statement on the peri‐operative management of direct oral anticoagulants in cardiac surgery

Medical treatment of patients before surgical myocardial revascularization

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