Written in Blood
Pre-Procedure Anticoagulation
Interruption May Not Be
Necessary
Patients with atrial fibrillation
(AF) on anticoagulation therapies
who require a surgical procedure
may require an interruption in the
therapy – depending on their risk
of post-procedural bleeding and
the likelihood of periprocedural
thrombotic events. According
to an analysis of data from the
ARISTOTLE trial, though, many
patients were able to undergo
surgical procedures safely without
interrupting or bridging therapy.
“These findings corroborate the
implications of many other studies,” lead author David Garcia,
MD, of the division of hematology,
University of Washington, Seattle,
told ASH Clinical News. “In 2014,
for patients with atrial fibrillation,
pre-procedure parenteral bridging
therapy looks increasingly unnecessary.”
The ARISTOTLE trial compared apixaban (an oral direct
factor Xa inhibitor) with warfarin
for the prevention of stroke or
systemic embolism in AF patients.
Apixaban, in contrast to warfarin
and other vitamin K antagonists,
has a rapid onset and offset of
anticoagulant activity – making
it an attractive option for patients
who require short-term protection from thrombosis before a
surgical procedure. According to
Dr. Garcia, physicians have more
experience with managing patients
taking warfarin who require surgical procedures than the newer
target-specific oral anticoagulants.
In this analysis, investigators
explored the management of anticoagulants and surgical outcomes
30 days post-procedure among
5,924 patients from the ARISTOTLE study who underwent a total of
40
ASH Clinical News
10,674 procedures. Overall, 5,439
patients had a procedure that met
study eligibility criteria. The most
common were dental extraction/
oral surgery (14.6%), colonoscopy
(9.9%), and ophthalmic surgery
(8.0%).
Local investigators chose to
interrupt anticoagulant treatment
pre-proc VGW&R