PMID- 32128791
OWN - NLM
STAT- MEDLINE
DCOM- 20210302
LR  - 20210302
IS  - 1365-2141 (Electronic)
IS  - 0007-1048 (Linking)
VI  - 190
IP  - 2
DP  - 2020 Jul
TI  - Effect of direct-acting oral anticoagulants (DOACs) on bleeding and blood product 
      usage in cardiac surgery compared to warfarin and controls.
PG  - 284-293
LID - 10.1111/bjh.16521 [doi]
AB  - In this retrospective, single-centre, observational study, we assessed (i) use of 
      anticoagulant and antiplatelet (AP) therapy, (ii) the duration of direct-acting 
      oral anticoagulant (DOAC) discontinuation, (iii) renal function and (iv) PT and 
      APTT as predictors of bleeding and blood product usage; in adults (>18 years) 
      undergoing major cardiac surgery from 01.01.2015 to 31.12.2018. Comparisons were 
      made between each treatment group (warfarin, DOAC and DOAC + AP) and untreated 
      controls, and between warfarin and DOAC. A total of 2928 patients were included 
      for analysis. Median (range) of DOAC discontinuation prior to surgery was 
      five days (1-22) for DOAC and five days (2-7) for DOAC + AP. There were no 
      differences in bleeding between anticoagulant groups versus control, or DOAC 
      versus warfarin. There were no differences in blood product use between DOAC and 
      warfarin patients. The duration of DOAC discontinuation but not the creatinine 
      clearance influenced bleeding and blood products use. Thrombosis occurred in 0.7% 
      and 3.1% in controls and patients on warfarin respectively (P = 0.099) with none 
      among patients on DOAC or DOAC + AP. The PT/APTT had no predictive value. Median 
      five-day discontinuation of DOAC +/- AP irrespective of renal function prevents 
      an increase in bleeding compared to patients on warfarin or controls with no 
      increase in thrombosis.
CI  - (c) 2020 British Society for Haematology and John Wiley & Sons Ltd.
FAU - Little, Christopher
AU  - Little C
AD  - Centre for Haematology, Department of Immunology and Inflammation, Imperial 
      College London, London, UK.
FAU - Szydlo, Richard
AU  - Szydlo R
AD  - Centre for Haematology, Department of Immunology and Inflammation, Imperial 
      College London, London, UK.
FAU - Aw, T C
AU  - Aw TC
AD  - Department of Anaesthesia, Royal Brompton Hospital & Harefield NHS Foundation 
      Trust, London, UK.
FAU - Laffan, Mike
AU  - Laffan M
AD  - Centre for Haematology, Department of Immunology and Inflammation, Imperial 
      College London, London, UK.
AD  - Department of Haematology, Imperial College Healthcare NHS Trust, London, UK.
FAU - Arachchillage, Deepa R J
AU  - Arachchillage DRJ
AUID- ORCID: 0000-0001-5993-4850
AD  - Centre for Haematology, Department of Immunology and Inflammation, Imperial 
      College London, London, UK.
AD  - Department of Haematology, Imperial College Healthcare NHS Trust, London, UK.
AD  - Department of Haematology, Royal Brompton Hospital & Harefield NHS Foundation 
      Trust, London, UK.
LA  - eng
PT  - Journal Article
DEP - 20200303
PL  - England
TA  - Br J Haematol
JT  - British journal of haematology
JID - 0372544
RN  - 0 (Anticoagulants)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/pharmacology/*therapeutic use
MH  - Cardiac Surgical Procedures/*methods
MH  - Female
MH  - Hemorrhage/*chemically induced
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Warfarin/pharmacology/*therapeutic use
MH  - Young Adult
OTO - NOTNLM
OT  - bleeding
OT  - cardiac surgery
OT  - direct-acting oral anticoagulant
OT  - thrombosis
OT  - warfarin
EDAT- 2020/03/05 06:00
MHDA- 2021/03/03 06:00
CRDT- 2020/03/05 06:00
PHST- 2019/11/24 00:00 [received]
PHST- 2020/01/12 00:00 [accepted]
PHST- 2020/03/05 06:00 [pubmed]
PHST- 2021/03/03 06:00 [medline]
PHST- 2020/03/05 06:00 [entrez]
AID - 10.1111/bjh.16521 [doi]
PST - ppublish
SO  - Br J Haematol. 2020 Jul;190(2):284-293. doi: 10.1111/bjh.16521. Epub 2020 Mar 3.