TY - JOUR
T1 - Direct oral anticoagulants or vitamin K antagonists in emergencies
T2 - comparison of management in an observational study
AU - Thrombosis and Haemostasis Society of Australia and New Zealand Anticoagulation Reversal and Events Study Collaborative
AU - Baker, Ross I.
AU - Gilmore, Grace
AU - Chen, Vivien
AU - Young, Laura
AU - Merriman, E.
AU - Curnow, Jennifer
AU - Joseph, J.
AU - Tiao, Jim Y.
AU - Chih, Jun
AU - McRae, S.
AU - Harper, P.
AU - Tan, Chee Wee
AU - Brighton, T.
AU - Royle, G.
AU - Hugman, Amanda
AU - Hankey, Graeme J.
AU - Crowther, Helen
AU - Boey, Jirping
AU - Gallus, A.
AU - Campbell, Philip
AU - Tran, Huyen
AU - Chen, V.
AU - Young, L.
AU - Merriman, E.
AU - Curnow, J.
AU - Gallus, A.
AU - Boey, J.
AU - Tan, Chee Wee
AU - McRae, S.
AU - Hugman, A.
AU - Joseph, J.
AU - Harper, P.
AU - Brighton, T.
AU - Royle, G.
AU - Crowther, H.
AU - Tran, H.
AU - Campbell, P.
AU - Baker, Ross I.
N1 - Funding Information:
The Anticoagulation Reversal and Events Study Collaborative was established from initial seed funding from the Thrombosis and Haemostasis Society of Australia and New Zealand clinical trial group and the Perth Blood Institute. Additional investigator-led research support was obtained from Takeda Pharmaceuticals International AG via Investigator-Initiated Research Grant (IISR-2017-104206/H14-22542, H11-00729). In addition, Bristol-Myers Squibb/Pfizer Alliance and Boehringer Ingelheim provided research support associated with administering the Anticoagulation Reversal and Events Study Collaborative database. However, these funders had no role in the study design, data interpretation, or manuscript writing.
Publisher Copyright:
© 2023 The Authors
PY - 2023/7
Y1 - 2023/7
N2 - 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.
AB - 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.
KW - anticoagulants
KW - coagulation
KW - dabigatran
KW - hemorrhage
KW - hemostatics
UR - http://www.scopus.com/inward/record.url?scp=85165687720&partnerID=8YFLogxK
U2 - 10.1016/j.rpth.2023.100196
DO - 10.1016/j.rpth.2023.100196
M3 - Article
C2 - 37601024
AN - SCOPUS:85165687720
VL - 7
JO - Research and Practice in Thrombosis and Haemostasis
JF - Research and Practice in Thrombosis and Haemostasis
IS - 5
M1 - 100196
ER -