Title
Perioperative Resumption of DOACs: The Mayo Experience (RESUME) Review
Department, Center, or Institute
Biology
Secondary Department, Center, or Institute
Modern Languages and Literatures
Presentation Format
Individual Oral Presentation
Presentation Type
Internship
Description
Background: To our knowledge, there are no reports of clinical guidelines that concern the resumption of direct oral anticoagulants (DOACs) after an elective procedure. Recently DOACs (i.e. apixiban, edoxaban, rivaroxaban, dabigatran) have been used for the treatment/prophylaxis of deep vein thromboses (DVT) and pulmonary emboli (PE) as well as stroke prophylaxis for non-valvular atrial fibrillation. DOACs have a shorter half-life than warfarin and research has shown that they are not inferior to warfarin. The typical recommendation in our clinic (Mayo Clinic Jacksonville, FL) is to resume 48-72 hours after surgery, if safe from a surgical standpoint.Objective: The objective of this study is to compile and review our recommendations and postoperative complications within 30 days. Also, offer guidance to clinicians providing preoperative evaluations for patients that are on DOACs undergoing elective surgical procedures.Methods: A retrospective chart review was conducted on patients who underwent evaluation and medical optimization from June 29thm 2018 at the Preoperative Evaluation (POE) Clinic in our institution. We looked for the time period of resumption of any DOAC and the complications within 30 days postoperatively.Results: There were a final total of 322 patients in the study. Of the 322 patients, 11 had complications. All resulting complications were found to be statistically insignificant except for the risk of DVT in relation to the >72 hour time period (p = 0.02.) Even though there were only 2 patients that presented with DVT in the > 72-hour time frame, it made up for 4.26% of the total. We ran comparison tests of the >72-hour time period against 0-48 hours and 48-72 hours to verify this significance.Conclusions: Review of our experience has shown that recommending patient to resume DOACs 48-72 hours postoperatively is not associated with any significant complications. However, postoperative DVT has been associated with resumption of DOACs after 72 hours postoperatively.
Department Organized Oral Session Title
Table 17: Medical/Healthcare
Moderator/Professor
Center for Engaged Learning (Staff), Internship Office
Session Number
6
Start Date and Time
4-9-2019 3:00 PM
Location
PAC Hallway
Recommended Citation
Carpenter, Emily, "Perioperative Resumption of DOACs: The Mayo Experience (RESUME) Review" (2019). Furman Engaged!. 173.
https://scholarexchange.furman.edu/furmanengaged/2019/all/173
Perioperative Resumption of DOACs: The Mayo Experience (RESUME) Review
PAC Hallway
Background: To our knowledge, there are no reports of clinical guidelines that concern the resumption of direct oral anticoagulants (DOACs) after an elective procedure. Recently DOACs (i.e. apixiban, edoxaban, rivaroxaban, dabigatran) have been used for the treatment/prophylaxis of deep vein thromboses (DVT) and pulmonary emboli (PE) as well as stroke prophylaxis for non-valvular atrial fibrillation. DOACs have a shorter half-life than warfarin and research has shown that they are not inferior to warfarin. The typical recommendation in our clinic (Mayo Clinic Jacksonville, FL) is to resume 48-72 hours after surgery, if safe from a surgical standpoint.Objective: The objective of this study is to compile and review our recommendations and postoperative complications within 30 days. Also, offer guidance to clinicians providing preoperative evaluations for patients that are on DOACs undergoing elective surgical procedures.Methods: A retrospective chart review was conducted on patients who underwent evaluation and medical optimization from June 29thm 2018 at the Preoperative Evaluation (POE) Clinic in our institution. We looked for the time period of resumption of any DOAC and the complications within 30 days postoperatively.Results: There were a final total of 322 patients in the study. Of the 322 patients, 11 had complications. All resulting complications were found to be statistically insignificant except for the risk of DVT in relation to the >72 hour time period (p = 0.02.) Even though there were only 2 patients that presented with DVT in the > 72-hour time frame, it made up for 4.26% of the total. We ran comparison tests of the >72-hour time period against 0-48 hours and 48-72 hours to verify this significance.Conclusions: Review of our experience has shown that recommending patient to resume DOACs 48-72 hours postoperatively is not associated with any significant complications. However, postoperative DVT has been associated with resumption of DOACs after 72 hours postoperatively.