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Urgent surgery or procedures in patients taking dabigatran or warfarin: Analysis of perioperative outcomes from the RE-LY trial
McMaster Univ, Dept Med, Hamilton, ON, Canada..
McMaster Univ, Dept Med, Hamilton, ON, Canada.;McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada..
Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany.;Mannheim Univ Heidelberg, Fac Med, Heidelberg, Germany..
Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany..
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2016 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 139, 77-81 p.Article, review/survey (Refereed) Published
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Abstract [en]

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.

Place, publisher, year, edition, pages
2016. Vol. 139, 77-81 p.
Keyword [en]
Urgent surgery, Dabigatran, Warfarin, Perioperative
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:uu:diva-285933DOI: 10.1016/j.thromres.2016.01.004ISI: 000370879300011PubMedID: 26916299OAI: oai:DiVA.org:uu-285933DiVA: diva2:921433
Available from: 2016-04-20 Created: 2016-04-20 Last updated: 2017-11-30Bibliographically approved

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Wallentin, LarsOldgren, Jonas

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