Douketis James D, Healey Jeff S, Brueckmann Martina, Fraessdorf Mandy, Spyropoulos Alex C, Wallentin Lars, Oldgren Jonas, Reilly Paul, Ezekowitz Michael D, Connolly Stuart J, Yusuf Salim, Eikelboom John W
Department of Medicine, McMaster University, Hamilton, Canada.
Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, McMaster University, Hamilton, Canada.
Thromb Res. 2016 Mar;139:77-81. doi: 10.1016/j.thromres.2016.01.004. Epub 2016 Jan 9.
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.
We accessed the database from RE-LY, a randomized trial comparing dabigatran (110mg and 150mg 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 110mg or 150mg, or warfarin) or surgery/procedure type (urgent or elective). Outcomes were assessed from day-7 to day 30 after a surgery/procedure.
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 110mg, dabigatran 150mg 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).
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.
对于需要紧急手术/操作的房颤抗凝患者的管理存在担忧，尤其是那些正在接受直接口服抗凝剂（如达比加群）治疗的患者。
我们查阅了RE-LY试验的数据库，该试验比较了达比加群（每日两次，110mg和150mg）与华法林用于房颤患者预防卒中的效果，以评估那些接受了紧急和择期手术/操作的患者。我们根据治疗分配（达比加群110mg或150mg，或华法林）或手术/操作类型（紧急或择期）比较了血栓栓塞、大出血和死亡风险。在手术/操作后第7天至第30天评估结果。
353例患者（占研究人群的2.0%）接受了紧急手术/操作，4168例患者（占研究人群的23.1%）接受了择期手术/操作。在接受紧急手术/操作的服用达比加群110mg、达比加群150mg和华法林的患者中：血栓栓塞发生率分别为16.1%、7.4%和10.5%；大出血发生率分别为17.0%、17.6%和22.9%；死亡率分别为6.3%、1.5%和2.9%（所有比较P>0.50）。这些结果的发生率在接受紧急手术/操作的患者中比接受择期手术/操作的患者高几倍（所有比较P<0.5）。
对于需要紧急手术/操作的房颤抗凝患者，血栓栓塞、大出血和死亡风险在达比加群或华法林治疗之间并无差异，但这些结果的发生率比接受择期手术/操作的患者高几倍。
