Evidence map›Paper›PMID 37601024›Full record

ArticleResearch and practice in thrombosis and haemostasis2023

Direct oral anticoagulants or vitamin K antagonists in emergencies: comparison of management in an observational study.

Ross I Baker, Grace Gilmore, Vivien Chen, Laura Young, Eileen Merriman, Jennifer Curnow, Joanne Joseph, Jim Y Tiao, Jun Chih, Simon McRae and 12 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Research and practice in thrombosis and haemostasis, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 2 pooled it
0.9field-weighted citation impact, top 24% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 2 syntheses or guidelines pooled it, 4 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Article
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

22 authors at 17 institutions in 2 countries.

Ross I BakerWestern Australia Centre for Thrombosis and Haemostasis, Murdoch University, Perth, Australia.
Grace GilmoreWestern Australia Centre for Thrombosis and Haemostasis, Murdoch University, Perth, Australia.
Vivien ChenConcord Repatriation General Hospital, Concord Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, Australia.
Laura YoungAuckland City Hospital, Grafton, Auckland, New Zealand.
Eileen MerrimanNorth Shore Hospital, Auckland, New Zealand.
Jennifer CurnowWestmead Hospital, Sydney, Australia.
Joanne JosephSt Vincent's Hospital and School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia.
Jim Y TiaoWestern Australia Centre for Thrombosis and Haemostasis, Murdoch University, Perth, Australia.
Jun ChihCurtin School of Population Health, Perth, Australia.
Simon McRaePerth Blood Institute, Perth, Australia.
Paul HarperPalmerston North Hospital, Palmerston North, New Zealand.
Chee W TanRoyal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
Timothy BrightonPrince of Wales Hospital, Sydney, Australia.
Gordon RoyleMiddlemore Hospital, Auckland, New Zealand.
Amanda HugmanSt George Hospital, Sydney, Australia.
Graeme J HankeyPerron Institute for Neurological and Translational Science and The University of Western Australia, Perth, Australia.
Helen CrowtherBlacktown Hospital, Sydney, Australia.
Jirping BoeyFlinders Medical Centre, Flinders University, Adelaide, Australia.
Alexander GallusFlinders Medical Centre, Flinders University, Adelaide, Australia.
Philip CampbellUniversity Hospital, Geelong, Australia.
Huyen TranAlfred Hospital, Melbourne, Australia.
Thrombosis and Haemostasis Society of Australia and New Zealand Anticoagulation Reversal and Events Study Collaborative
Flinders University · AUMurdoch University · AUAuckland City Hospital · NZBlacktown & Mount Druitt Hospital · AUGeelong Hospital · AUMiddlemore Hospital · NZNorth Shore Hospital · NZPalmerston North Hospital · NZPrince of Wales Hospital · AURoyal Adelaide Hospital · AUSt George Hospital · AUThe Alfred Hospital · AUThe University of Sydney · AUUNSW Sydney · AUWestmead Hospital · AUCurtin University · AUThe University of Western Australia · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Restoring hemostasis in patients on oral anticoagulants presenting with major hemorrhage (MH) or before surgical intervention has changed, with the replacement of vitamin K antagonist (VKA) with direct oral anticoagulants (DOACs). Objectives: To observe the difference in urgent hemostatic management between patients on VKA and those on DOACs. Methods: A multicenter observational study evaluated the variation in laboratory testing, hemostatic management, mortality, and hospital length of stay (LOS) in patients on VKA or DOACs presenting with MH or urgent hemostatic restoration. Results: Of the 1194 patients analyzed, 783 had MH (61% VKA) and 411 required urgent hemostatic restoration before surgery (56% VKA). Compared to the international normalized ratio (97.6%), plasma DOAC levels were measured less frequently (<45%), and the time taken from admission for the coagulation sample to reach the laboratory varied widely (median, 52.3 minutes; IQR, 24.8-206.7). No significant plasma DOAC level (<50 ng/mL) was found in up to 19% of patients. There was a poor relationship between plasma DOAC level and the usage of a hemostatic agent. When compared with patients receiving VKA (96.5%) or dabigatran (93.7%), fewer patients prescribed a factor Xa inhibitor (75.5%) received a prohemostatic reversal agent. The overall 30-day mortality for MH (mean: 17.8%) and length of stay (LOS) (median: 8.7 days) was similar between VKA and DOAC patients. Conclusion: In DOAC patients, when compared to those receiving VKA, plasma DOAC levels were measured less frequently than the international normalized ratio and had a poor relationship with administering a hemostatic reversal agent. In addition, following MH, mortality and LOS were similar between VKA and DOAC patients.

Indexed as

anticoagulantscoagulationdabigatranhemorrhagehemostatics

Identifiers

PMID37601024
PMCPMC10439397
OpenAlexW4378472850

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.