No difference in bleeding, thromboembolic events with DOACs and warfarin after surgery | Jobs Reply


December 15, 2022

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Patients who received apixaban or rivaroxaban after cardiac surgery were no more likely to experience major bleeding or thromboembolic events compared with patients who received warfarin after surgery, data from a single-center study show.

“Landmark studies of major direct oral anticoagulant agents were not designed to analyze outcomes in cardiac surgery patients.” Alan J. Rozycki, PharmD, BCCCP, of the department of pharmacy at Ohio State University Wexner Medical Center, and colleagues wrote the background to the study. “Due to the limitations of the available data, questions remain regarding the safety and efficacy of initiating apixaban or rivaroxaban during index hospitalization in patients undergoing cardiac surgery.”

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Patients who received apixaban or rivaroxaban after cardiac surgery were not more likely to experience major bleeding or thromboembolic events compared with patients who received warfarin after surgery.
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In a retrospective study, Rozycki and colleagues performed cardiac surgery between January 2013 and October 2021 and discharged at least one dose of rivaroxaban (Xarelto, Janssen/Bayer), apixaban, or warfarin (Xarelto, Janssen/Bayer), apixaban, or warfarin in 194 adults. they analyzed the data. Patients were stratified by use of direct oral anticoagulants (DOAC; n = 97; mean age, 64 years) or warfarin (n = 97; mean age, 67 years). The primary outcome was the International Society of Thrombosis and Haemostasis (ISTH) major bleeding rate during hospitalization and 30 days after discharge or until the first follow-up appointment.

“We correlated the type of procedure, antiplatelets, indications for anticoagulation, and pump on and off for CABG procedures,” the researchers wrote. “Using this approach was able to control for important comorbidities that could predispose patients to bleeding or thrombosis. In addition, all patients in this study were started on an oral anticoagulant during cardiac surgery hospitalization and within 7 days of the cardiac procedure.

The findings were published in the journal Journal of Cardiac Surgery.

Within the cohort, four patients (4.1%) in the DOAC group and two patients (2.1%) in the warfarin group experienced major ISTH bleeding (P = .68). No patients in the DOAC cohort experienced thrombotic events, whereas two patients (2.1%) in the warfarin cohort experienced thrombotic complications (P = .5).

“There was no statistically significant difference in ISTH bleeding or thromboembolic events between the two groups,” the researchers wrote. “The promising results of this study underscore the need for a large, prospective, randomized clinical trial to draw definitive conclusions about the safety of apixaban and rivaroxaban compared with warfarin in patients who have recently undergone cardiac surgery.”



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