Periinterventional management of novel oral anticoagulants: results of the prospective Dresden NOAC registry

Beyer‐Westendorf, Jan; Gelbricht, Vera; Foerster, Kathrin I.; Ebertz, Franziska; Koehler, Christina; Tittl, Luise; Werth, Sebastian

doi:10.1093/eurheartj/eht310.p5444

Cited by 11 publications

(21 citation statements)

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“…The results from the prospective Dresden novel oral anticoagulant registry showed that HBT during peri-procedural management of transluminal cardiac, arterial, and venous interventions did not reduce cardiovascular events but was associated with a significant increase in the incidence of major bleeding (2.7% vs 0.5%, P = 0.01) compared with the absence of HBT. 12 In a sub-study of the RE-LY trial, HBT after the cessation of dabigatran also resulted in higher rates of major bleeding (6.5% vs 1.8%, P < 0.001) with no significant reduction in thromboembolism compared with non-HBT. 18 However, no reports have described colonic EMR in patients taking DOACs without HBT.…”

Section: Discussionmentioning

confidence: 93%

“…5 The half-time metabolism of DOACs is 5 h to 17 h. 11 The short half-lives of these drugs reduce the interval of pre-procedural interruption to 1 or 2 days, and their fast onset of action achieves the rapid restitution of anticoagulant activity after the procedure. 12 In the patients taking DOACs the resection was performed on the next day of hospitalization regardless of their PT-INR. Oral administration of DOACs was omitted on the morning of the resection and restarted at the same dose later that day.…”

Section: Non-hbt Groupmentioning

confidence: 99%

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Colonic endoscopic mucosal resection in patients taking anticoagulants: Is heparin bridging therapy necessary?

Fujita

Murao

Osawa

et al. 2018

J of Digest Diseases

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Section: Discussionmentioning

confidence: 93%

Section: Non-hbt Groupmentioning

confidence: 99%

Colonic endoscopic mucosal resection in patients taking anticoagulants: Is heparin bridging therapy necessary?

Fujita

Murao

Osawa

et al. 2018

J of Digest Diseases

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“…However, a recent prospective registry of .2,100 patients on the DOACs provides additional evidence that bridging anticoagulation should only be used for patients with a high risk for thromboembolism. 12 Like the BRIDGE trial, they found that while heparin bridging of patients on DOACs did not decrease cardiovascular events, it did increase the risk of bleeding significantly (2.7%; 95% confidence interval [CI] 1.1-5.5) compared with no bridging (0.5%; 0.1-1.4; P ¼ 0.010). Consistent with this finding, the most recent European Heart Rhythm Guidelines recommend against bridging if the patient is on a DOAC.…”

Section: Direct Oral Anticoagulants (Doacs) Versus Warfarinmentioning

confidence: 98%

Periprocedural Antithrombotic Therapy: A Practical Guide for Clinical Practice

Moore

Langeberg

Trager

et al. 2017

Journal of the Minneapolis Heart Institute Foundation

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More than 6 million patients are on anticoagulant therapy and more than one third of adults take antiplatelet therapy in the United States, many of whom will require a surgical procedure while on treatment. The answers to questions regarding periprocedural thrombotic therapy are not at all straightforward and there is tremendous variability in practice across the country and across specialties. While there will always be nuances in clinical care that necessitate variation in practice patterns, algorithms for care allow for less ambiguity and they provide guidelines that are consistent with the most recent evidence in the literature. In this review, we provide: 1) a framework for periprocedureal antithrombotic therapy around the time of surgical procedures, 2) an approach for considering the risk of bleeding at the time of surgery as well as the risk of a thrombotic or thromboembolic event should the antithrombotic therapy be stopped, and 3) a strategy for managing periprocedural bridging therapy. KEY WORDSperiprocedural anticoagulation, antithrombotic therapy, thrombosis, bleeding risk, oral anticoagulation. n IS ANTITHROMBOTIC THERAPY REQUIRED?Answering a question regarding antithrombotic therapy should start with the consideration of whether or not the anticoagulation is still indicated in the first place. However, assuming the patient still has an indication for anticoagulation (and assuming a non-emergent surgery), the next question involves answering questions regarding surgical bleeding risk and the risk of thrombosis/thromboembolism if therapy is withheld. n BLEEDING RISKOne of the major risk-stratifications in assessing bleeding risk involves the risk inherent to the surgery or procedure. There is minimal data to guide decisions regarding procedural bleeding risk. The 2 main factors that impact bleeding risk are the type of procedure and the patient factors that interfere with hemostasis. A frequently cited reference with regard to surgical bleeding is from the American College of Chest Physicians, 1 which used expert consensus to generate a list of high-risk procedures. Interestingly, the major reference for surgical bleeding risk dates back to a metaanalysis of perioperative subcutaneous heparin use for the prevention of pulmonary embolism in 1988.2 Table 1 includes a list of high-risk procedures compiled from these consensus guidelines as well as another recent review. 1,3 In general, this list comprises surgeries that involve highly vascular organs or large incisions. An extensive list of surgical procedures and their associated risk has also been compiled as an appendix to a recent review on periprocedural antithrombotic therapy 4 (also based on expert opinion).There are several validated nonprocedural factors that increase bleeding risk and these include abnormal renal function, nonsteroidal anti-inflammatory medications, low platelet count, and liver disease/coagulopathy. These factors have been combined into a variety of bleeding risk scores: (1) and (4) ATRIA (anticoagulation and risk f...

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“…The American College of Chest Physicians (ACCP) recommends stopping vitamin K antagonists (VKAs) five days before surgery and advises that patients taking VKA who are at high risk of thromboembolism (mechanical heart valve, atrial fibrillation (AF), or VTE) be 'bridged' with LMWH. 19 On the other hand, for patients at low risk of thromboembolism no covering therapy is required when stopping anticoagulants electively. 20 In case of surgery or an invasive procedure, the degree of urgency should be assessed in order to decrease the bleeding risk: Non-VKA therapy must be discontinued, time of the last dose should be known and recorded, and where possible invasive procedures should be delayed until the effect of non-VKA medication is reduced.…”

Section: Patients On Long-term Anticoagulationmentioning

confidence: 99%

“…Although limited data are available, Beyer-Westendorf et al concluded that short-term interruption is safe for most invasive procedures and that bridging therapy may not be required in patients on NOACs preoperatively. 19 The British Society of Haematology recommends that postoperative bridging therapy should not be started until at least 48 hours after high-risk surgery. Patients with a bileaflet aortic mechanical heart valve (MHV) with no other risk factors do not require bridging therapy.…”

Section: Perioperative Anticoagulation and Bridgingmentioning

confidence: 99%

Haematological considerations in urology: A systematic review

Abusanad

Floyd

Johnson

et al. 2015

Journal of Clinical Urology

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Deep venous thrombosis (DVT) remains a serious and common complication of surgical procedures and is therefore an issue of importance for all urologists. In the UK, pulmonary embolism (PE) following DVT in hospitalised patients causes 32,000 deaths each year. DVT and PE represent the outcome of venous thromboembolism (VTE). The total cost for management of VTE in 2005 was approximately ₤640 million. Early risk assessment and optimising modifiable risks are paramount in order to reduce the incidence of VTE. In this article we review common risk factors for VTE and emphasise specific risk factors for urological procedures. The perioperative management of urological patients who are chronically anticoagulated is discussed. We review the literature regarding anticoagulation and its relevance to all urological procedures and mention the problems associated with new anticoagulant agents. All urologists should be familiar with the new range of anticoagulant agents due to the increasing number of patients taking them.

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Periinterventional management of novel oral anticoagulants: results of the prospective Dresden NOAC registry

Cited by 11 publications

References 0 publications

Colonic endoscopic mucosal resection in patients taking anticoagulants: Is heparin bridging therapy necessary?

Colonic endoscopic mucosal resection in patients taking anticoagulants: Is heparin bridging therapy necessary?

Periprocedural Antithrombotic Therapy: A Practical Guide for Clinical Practice

Haematological considerations in urology: A systematic review

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