A Survey of Direct Oral Anticoagulant Cessation in General Surgery and Outcomes in Patients with Nonvalvular Atrial Fibrillation
A Survey of Direct Oral Anticoagulant Cessation in General Surgery and Outcomes in Patients with Nonvalvular Atrial Fibrillation
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DOI：
10.1536/ihj.19-625
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发表时间：
2020-09-01
影响因子：
1.5
通讯作者：
Hirao, Kenzo
中科院分区：
文献类型：
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作者：
Kawabata, Mihoko;Goya, Masahiko;Hirao, Kenzo
我们回顾性评估了85例接受直接口服抗凝剂（DOAC）的非瓣膜性房颤（AF）患者（年龄73 ± 8岁，59例男性）的98例手术。排除心脏、急诊和微创手术，CHA（2）DS（2）-VASc评分范围为0 - 8。给予的DOAC为：达比加群，16;利伐沙班，25;阿哌沙班，28;和依度沙班。16.虽然11例病例未暂停DOAC，但在术前中断中位2.0天，并在术后中位3.0天重新开始。并发症9例（9.2%），血栓栓塞3例，出血6例。血栓栓塞发生在术后平均3.0天，所有事件均发生在恢复DOAC之前，而出血事件发生在术后平均4.0天。3例血栓栓塞患者中有2例在事件发生期间发生心肺骤停，但均复苏。并发症患者中充血性心力衰竭或联合抗血小板治疗者明显增多。并发症组的IIAS-BLED评分显著较高，术前血红蛋白水平较低。有并发症和无并发症患者的DOAC中断处理无显著差异，非瓣膜性AF患者择期手术DOAC治疗的围手术期并发症发生率为9.2%。充血性心力衰竭、接受抗血小板联合治疗、HAS-BLED评分较高或术前血红蛋白水平较低的患者风险较高。进一步的研究评价理想的围手术期DOAC协议是必要的。
There is little data on management and outcomes of atrial fibrillation (AF) patients on direct oral anticoagulants (DOAC) undergoing general surgery.We retrospectively assessed 98 surgeries in 85 nonvalvular AF patients aged 73 +/- 8 (59 men) receiving DOACs. Cardiac, emergency, and minimally invasive surgeries were excluded.The CHA(2)DS(2)-VASc score ranged from 0 to 8. The DOACs being given were: dabigatran, 16; rivaroxaban, 25; apixaban, 28; and edoxaban. 16. While the DOACs were not suspended in 11 cases, they were interrupted for a median of 2.0 days before surgery and restarted at a median of 3.0 days after surgery. There were 9 complications (9.2%), 3 instances of thromboembolism and 6 bleeding. Thromboembolism occurred at a mean of 3.0 postoperative days, all of which occurred before resumption of DOACs, while bleeding events occurred at a mean of 4.0 postoperative days. Two of the 3 patients with thromboembolism went into cardiopulmonary arrest during the event, but were resuscitated. There were significantly more patients with congestive heart failure or combined antiplatelets in the patients with complications. The complication group had a significantly higher IIAS-BLED score and lower preoperative hemoglobin level. There were no significant differences in the management of DOAC interruption between those with complications and without.The perioperative complication rate in nonvalvular AF patients undergoing elective surgery treating with DOACs was 9.2%. Patients with congestive heart failure, receiving combined therapy with antiplatelets, a higher HAS-BLED score, or lower preoperative hemoglobin level were at higher risk. Further studies evaluating the ideal perioperative DOAC protocol are warranted.