Urgent surgery or procedures in patients taking dabigatran or warfarin: Analysis of perioperative outcomes from the RE-LY trial

被引:31
|
作者
Douketis, James D. [1 ]
Healey, Jeff S. [1 ,2 ]
Brueckmann, Martina [3 ,5 ]
Fraessdorf, Mandy [3 ]
Spyropoulos, Alex C. [4 ]
Wallentin, Lars [7 ,8 ]
Oldgren, Jonas [7 ,8 ]
Reilly, Paul [9 ]
Ezekowitz, Michael D. [6 ]
Connolly, Stuart J. [1 ,2 ]
Yusuf, Salim [1 ,2 ]
Eikelboom, John W. [1 ,2 ]
机构
[1] McMaster Univ, Dept Med, Hamilton, ON, Canada
[2] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada
[3] Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany
[4] Hofstra North Shore Long Isl Jewish Sch Med, Manhasset, NY USA
[5] Mannheim Univ Heidelberg, Fac Med, Heidelberg, Germany
[6] Jefferson Med Coll, Wynnewood, PA USA
[7] Uppsala Univ, Uppsala Clin Res Ctr, Stockholm, Sweden
[8] Uppsala Univ, Dept Med Sci Cardiol, Stockholm, Sweden
[9] Boehringer Ingelheim Pharmaceut, Ridgefield, CT USA
关键词
Urgent surgery; Dabigatran; Warfarin; Perioperative; VITAMIN-K ANTAGONISTS; ORAL ANTICOAGULANTS; MANAGEMENT; REVERSAL; PREVENTION; THERAPY; EVENTS;
D O I
10.1016/j.thromres.2016.01.004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: There is concern about the management of anticoagulated patients with atrial fibrillation (AF) who require an urgent surgery/procedure, especially in those who are receiving a direct oral anticoagulant such as dabigatran. Methods: We accessed the database from RE-LY, a randomized trial comparing dabigatran (110 mg and 150 mg twice daily) with warfarin for stroke prevention in AF, to assess patients who had an urgent and elective surgery/procedure. We compared the risk for thromboembolism, major bleeding and mortality according to treatment allocation (dabigatran 110 mg or 150 mg, or warfarin) or surgery/procedure type (urgent or elective). Outcomes were assessed from day-7 to day 30 after a surgery/procedure. Results: 353 patients (2.0% of study population) had an urgent surgery/procedure and 4168 patients (23.1% of study population) had an elective surgery/procedure. In patients on dabigatran 110 mg, dabigatran 150 mg and warfarin who had an urgent surgery/procedure: rates of thromboembolism were 16.1%, 7.4%, and 10.5%; rates of major bleeding were 17.0%, 17.6%, and 22.9%; rates of mortality were 6.3%, 1.5%, and 2.9%, respectively (P > 0.50 for all comparisons). Rates of these outcomes were multi-fold higher in patients having an urgent rather than an elective surgery/procedure (P < 0.5 for all comparisons). Conclusion: In anticoagulated patients with atrial fibrillation who require an urgent surgery/procedure, the risks for thromboembolism, major bleeding and mortality did not differ depending on treatment with dabigatran or warfarin, but rates of these outcomes were multi-fold higher than in patients having an elective surgery/procedure. (C) 2016 Elsevier Ltd. All rights reserved.
引用
收藏
页码:77 / 81
页数:5
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