Evidence map›Paper›PMID 31989095›Full record

ArticleResearch and practice in thrombosis and haemostasis2020

Perioperative interruption of direct oral anticoagulants and vitamin K antagonists in patients with atrial fibrillation: A comparative analysis.

Joseph R Shaw, Tinghua Zhang, Gregoire Le Gal, James Douketis, Marc Carrier

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Research and practice in thrombosis and haemostasis, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06844227 (Perioperative Anticoagulant Use for Surgery Evaluation -Virtual Visit), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.0field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06844227 recruitingnot on this mapstarted 2021, after this paper: background citation

Perioperative Anticoagulant Use for Surgery Evaluation -Virtual Visit (PAUSE-Virtual), a Simple Perioperative Anticoagulant Management Approach, Replacing a Resource-intensive In-person Doctor-patient Consultation, With a Simple Virtual Care Model That Will Provide a New Standard of Care for Patients on a Direct Oral Anticoagulant or Warfarin and Require Elective Surgery/Procedure.

TypeobservationalSponsorMcMaster UniversityRan2021 to 2026Enrolled1,780ConditionsAtrial Fibrillation (AF)
3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 9 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Joseph R ShawDepartment of Medicine Ottawa Hospital Research Institute at the University of Ottawa Ottawa ON Canada.
Tinghua ZhangDepartment of Medicine Ottawa Hospital Research Institute at the University of Ottawa Ottawa ON Canada.
Gregoire Le GalDepartment of Medicine Ottawa Hospital Research Institute at the University of Ottawa Ottawa ON Canada.ORCID https://orcid.org/0000-0002-9253-248X
James DouketisDivision of Hematology and Thromboembolism Department of Medicine McMaster University Hamilton ON Canada.
Marc CarrierDepartment of Medicine Ottawa Hospital Research Institute at the University of Ottawa Ottawa ON Canada.ORCID https://orcid.org/0000-0001-8296-2972
University of Ottawa · CAMcMaster University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere is a paucity of studies comparing postoperative thromboembolic and major bleeding complications following perioperative interruption of the direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). OBJECTIVE/

methodsWe conducted a retrospective cohort study to compare postoperative thromboembolic and major bleeding outcomes following perioperative interruption of DOACs and VKAs in patients with atrial fibrillation. The primary efficacy and safety outcomes were the 30-day postoperative rates of arterial thromboembolic events (ATEs) and major bleeding, respectively. The secondary outcomes included the 30-day rates of clinically relevant nonmajor bleeding (CRNMB) and overall mortality. Thromboembolic, major bleeding, and mortality outcomes were independently adjudicated. Multivariable mixed-effects logistic-regression models were used to adjust for potential confounding variables between the DOAC and VKA cohorts.

resultsA total of 325 DOAC patients undergoing 351 procedures and 199 VKA patients undergoing 221 procedures were included. The 30-day ATE rate was 0.57% (95% confidence interval [CI], 0.27-0.8) in the DOAC cohort. There were no ATEs in the VKA cohort. The 30-day rates of major bleeding were 0.57% (95% CI, 0.27-0.8) and 3.62% (95% CI, 0-7.3) in the DOAC and the VKA cohorts, respectively. There were significantly more postoperative major bleeding events in the VKA cohort. The 30-day rate of CRNMB was 4.27% (95% CI, 4.15-4.42) in the DOAC cohort and 4.52% (95% CI, 3.67-5.38) in the VKA cohort. There were 2 deaths in the VKA cohort, one of which was deemed to be a fatal nonsurgical bleeding event.

conclusionsThe perioperative interruption of VKAs may be associated with higher postoperative major bleeding rates as compared to DOACs. Careful postoperative reinitiation and monitoring of VKA anticoagulation may be warranted following surgical procedures.

Indexed as

anticoagulantsapixabanatrial fibrillationdabigatranperioperative periodpostoperative complicationsrivaroxabanwarfarin

Identifiers

PMID31989095
PMCPMC6971332
OpenAlexW3000891578

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.