Jan Beyer-Westendorf1, Vera Gelbricht2, Kati Förster2, Franziska Ebertz2, Christina Köhler2, Sebastian Werth2, Eberhard Kuhlisch3, Thoralf Stange3, Christoph Thieme2, Katharina Daschkow2, Norbert Weiss2. 1. Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Fetscherstrasse 74, 01307 Dresden, Germany jan.beyer@uniklinikum-dresden.de. 2. Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital 'Carl Gustav Carus' Dresden, Fetscherstrasse 74, 01307 Dresden, Germany. 3. Institute for Medical Informatics and Biometry, Technical University Dresden, Dresden, Germany.
Abstract
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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 NOACpatients. 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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Domenico Prisco; Walter Ageno; Cecilia Becattini; Armando D'Angelo; Giovanni Davì; Raimondo De Cristofaro; Francesco Dentali; Giovanni Di Minno; Anna Falanga; Gualberto Gussoni; Luca Masotti; Gualtiero Palareti; Pasquale Pignatelli; Roberto M Santi; Francesca Santilli; Mauro Silingardi; Antonella Tufano; Francesco Violi Journal: Intern Emerg Med Date: 2017-02-13 Impact factor: 3.397
Authors: Daniel M Witt; Robby Nieuwlaat; Nathan P Clark; Jack Ansell; Anne Holbrook; Jane Skov; Nadine Shehab; Juliet Mock; Tarra Myers; Francesco Dentali; Mark A Crowther; Arnav Agarwal; Meha Bhatt; Rasha Khatib; John J Riva; Yuan Zhang; Gordon Guyatt Journal: Blood Adv Date: 2018-11-27