Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry

被引:279
作者
Beyer-Westendorf, Jan [1 ,2 ]
Gelbricht, Vera [1 ,2 ]
Foerster, Kati [1 ,2 ]
Ebertz, Franziska [1 ,2 ]
Koehler, Christina [1 ,2 ]
Werth, Sebastian [1 ,2 ]
Kuhlisch, Eberhard [3 ]
Stange, Thoralf [3 ]
Thieme, Christoph [1 ,2 ]
Daschkow, Katharina [1 ,2 ]
Weiss, Norbert [1 ,2 ]
机构
[1] Univ Hosp Carl Gustav Carus Dresden, Ctr Vasc Med, Fetscherstr 74, D-01307 Dresden, Germany
[2] Univ Hosp Carl Gustav Carus Dresden, Dept Med 3, Div Angiol, D-01307 Dresden, Germany
[3] Tech Univ Dresden, Inst Med Informat & Biometry, D-01062 Dresden, Germany
关键词
Oral anticoagulants; Apixaban; Dabigatran; Rivaroxaban; Bridging; Invasive procedures; VITAMIN-K-ANTAGONISTS; BRIDGING ANTICOAGULATION; WARFARIN; RIVAROXABAN; DABIGATRAN;
D O I
10.1093/eurheartj/eht557
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Patients receiving novel oral anticoagulants (NOACs) frequently undergo interventional procedures. Short half-lives and rapid onset of action allow for short periods of NOAC interruption without heparin bridging. However, outcome data for this approach are lacking. We evaluated the peri-interventional NOAC management in unselected patients from daily care. Methods and results Effectiveness and safety data were collected from an ongoing, prospective, non-interventional registry of >2100 NOAC patients. Outcome events were adjudicated using standard event definitions. Of 2179 registered patients, 595 (27.3%) underwent 863 procedures (15.6% minimal, 74.3% minor, and 10.1% major procedures). Until Day 30 +/- 5 post-procedure, major cardiovascular events occurred in 1.0% of patients [95% confidence interval (95% CI) 0.5-2.0] and major bleeding complications in 1.2% (95% CI 0.6-2.1). Cardiovascular and major bleeding complications were highest after major procedures (4.6 and 8.0%, respectively). Heparin bridging did not reduce cardiovascular events, but led to significantly higher rates of major bleeding complications (2.7%; 95% CI 1.1-5.5) compared with no bridging (0.5%; 0.1-1.4; P = 0.010). Multivariate analysis demonstrated diabetes [odds ratio (OR) 13.2] and major procedures (OR 7.3) as independent risk factors for cardiovascular events. Major procedures (OR 16.8) were an independent risk factor for major bleeding complications. However, if major and non-major procedures were separately assessed, heparin bridging was not an independent risk factor for major bleeding. Conclusion Continuation or short-term interruption of NOAC is safe strategies for most invasive procedures. Patients at cardiovascular risk undergoing major procedures may benefit from heparin bridging, but bleeding risks need to be considered.
引用
收藏
页码:1888 / 1896
页数:9
相关论文
共 16 条
[1]  
[Anonymous], 2012, CHEST S
[2]   Oral Rivaroxaban for Symptomatic Venous Thromboembolism. [J].
Bauersachs, Rupert ;
Berkowitz, Scott D. ;
Brenner, Benjamin ;
Buller, Harry R. ;
Decousus, Herve ;
Gallus, Alex S. ;
Lensing, Anthonie W. ;
Misselwitz, Frank ;
Prins, Martin H. ;
Raskob, Gary E. ;
Segers, Annelise ;
Verhamme, Peter ;
Wells, Phil ;
Agnelli, Giancarlo ;
Bounameaux, Henri ;
Cohen, Alexander ;
Davidson, Bruce L. ;
Piovella, Franco ;
Schellong, Sebastian .
NEW ENGLAND JOURNAL OF MEDICINE, 2010, 363 (26) :2499-2510
[3]   Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism [J].
Buller, Harry R. ;
Prins, Martin H. ;
Lensing, Anthonie W. A. ;
Decousus, Herve ;
Jacobson, Barry F. ;
Minar, Erich ;
Chlumsky, Jaromir ;
Verhamme, Peter ;
Wells, Phil ;
Agnelli, Giancarlo ;
Cohen, Alexander ;
Berkowitz, Scott D. ;
Bounameaux, Henri ;
Davidson, Bruce L. ;
Misselwitz, Frank ;
Gallus, Alex S. ;
Raskob, Gary E. ;
Schellong, Sebastian ;
Segers, Annelise .
NEW ENGLAND JOURNAL OF MEDICINE, 2012, 366 (14) :1287-1297
[4]   Dabigatran versus Warfarin in Patients with Atrial Fibrillation. [J].
Connolly, Stuart J. ;
Ezekowitz, Michael D. ;
Yusuf, Salim ;
Eikelboom, John ;
Oldgren, Jonas ;
Parekh, Amit ;
Pogue, Janice ;
Reilly, Paul A. ;
Themeles, Ellison ;
Varrone, Jeanne ;
Wang, Susan ;
Alings, Marco ;
Xavier, Denis ;
Zhu, Jun ;
Diaz, Rafael ;
Lewis, Basil S. ;
Darius, Harald ;
Diener, Hans-Christoph ;
Joyner, Campbell D. ;
Wallentin, Lars .
NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (12) :1139-1151
[5]   Contra: "Bridging anticoagulation is needed during warfarin interruption when patients require elective surgery" [J].
Douketis, James D. .
THROMBOSIS AND HAEMOSTASIS, 2012, 108 (02) :210-212
[6]   Bridging Evidence-Based Practice and Practice-Based Evidence in Periprocedural Anticoagulation [J].
Gallego, Pilar ;
Apostolakis, Stavros ;
Lip, Gregory Y. H. .
CIRCULATION, 2012, 126 (13) :1573-1576
[7]   Bridging anticoagulation for patients on long-term vitamin-K-antagonists. A prospective 1 year registry of 311 episodes [J].
Halbritter, KM ;
Wawer, A ;
Beyer, J ;
Oettler, W ;
Schellong, SM .
JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 2005, 3 (12) :2823-2825
[8]   Periprocedural Bleeding and Thromboembolic Events With Dabigatran Compared With Warfarin Results From the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) Randomized Trial [J].
Healey, Jeff S. ;
Eikelboom, John ;
Douketis, James ;
Wallentin, Lars ;
Oldgren, Jonas ;
Yang, Sean ;
Themeles, Ellison ;
Heidbuchle, Hein ;
Avezum, Alvaro ;
Reilly, Paul ;
Connolly, Stuart J. ;
Yusuf, Salim ;
Ezekowitz, Michael .
CIRCULATION, 2012, 126 (03) :343-348
[9]   European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation [J].
Heidbuchel, Hein ;
Verhamme, Peter ;
Alings, Marco ;
Antz, Matthias ;
Hacke, Werner ;
Oldgren, Jonas ;
Sinnaeve, Peter ;
Camm, A. John ;
Kirchhof, Paulus .
EUROPACE, 2013, 15 (05) :625-651
[10]   Managing New Oral Anticoagulants in the Perioperative and Intensive Care Unit Setting [J].
Levy, Jerrold H. ;
Faraoni, David ;
Spring, Jenna L. ;
Douketis, James D. ;
Samama, Charles M. .
ANESTHESIOLOGY, 2013, 118 (06) :1466-1474