• J. Cardiothorac. Vasc. Anesth. · Dec 2022

    Multicenter Study

    The Effect of Direct Oral Anticoagulants on Outcomes After Urgent or Emergent Cardiac Surgery.

    • Jason P Hecht, Jean Huang, Andrew Pruitt, Ajay Gupta, Melissa J Clark, Chang He, and Kara Brockhaus.
    • Department of Pharmacy Services, Saint Joseph Mercy Ann Arbor, Ann Arbor, MI. Electronic address: Jason.Hecht@stjoeshealth.org.
    • J. Cardiothorac. Vasc. Anesth. 2022 Dec 1; 36 (12): 427342804273-4280.

    ObjectiveTo determine the safety of performing urgent or emergent cardiac surgery within 5 days of a patient taking a direct oral anticoagulant (DOAC).DesignA multicenter retrospective registry study.SettingThirty-three hospitals in a quality collaborative from 2017 to 2019.ParticipantsPatients were included if they underwent urgent or emergent coronary artery bypass grafting (CABG). Patients were excluded if they received any anticoagulant or antiplatelet agent besides DOACs, heparin, or aspirin.InterventionsPatients were stratified based upon the receipt of a DOAC within 5 days of their surgery. Patient cohorts included DOAC within 2 days, DOAC within 3-to-5 days, and no anticoagulation. Data were unavailable on the specific DOAC agent taken prior to admission.Measurements And Main ResultsThere were 7,201 patients included, with 94 on DOACs. Intraoperative blood transfusion was required in 23.9% of patients on no anticoagulant, 26.2% on a DOAC within 3-to-5 days of surgery (odds ratio [OR] 0.98; 95% CI 0.46-2.11), and 30.3% on a DOAC within 2 days (OR 0.99; 95% CI 0.37-2.67). Five or more intraoperative blood products were required in 4.4% on no anticoagulant, 1.7% on DOAC within 3-to-5 days (OR 0.33; 95% CI 0.04-2.71), and 6.1% on DOAC within 2 days (OR 0.47; 95% CI 0.06-4.05). No difference in mortality was observed among the 3 groups (2.9% v 3.3% v 3.0%; p = 0.67).ConclusionsFor urgent or emergent CABGs, no significant differences in minor bleeding, major bleeding, or mortality were observed in patients taking a DOAC within 5 days of surgery. This study was hypothesis-generating for performing urgent or emergent surgery sooner than 5 days after holding DOACs.Copyright © 2022 Elsevier Inc. All rights reserved.

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