Direct oral anticoagulants or Vitamin K antagonists in emergencies: comparison of management in an observational study

R.I. Baker; G. Gilmore; V. Chen; L. Young; E. Merriman; J. Curnow; J. Joseph; J.Y. Tiao; J. Chih; S. McRae; P. Harper; C.W. Tan; T. Brighton; G. Royle; A. Hugman; G. Hankey; H. Crowther; J. Boey; A. Gallus; P. Campbell; H. Tran; Chee Wee Tan; R. Baker; Thrombosis and Haemostasis Society of Australia and New Zealand ARES Study Collaborative

doi:10.1016/j.rpth.2023.100196

Back

Direct oral anticoagulants or Vitamin K antagonists in emergencies: comparison of management in an observational study

Journal article

Open access

Peer reviewed

Direct oral anticoagulants or Vitamin K antagonists in emergencies: comparison of management in an observational study

R.I. Baker, G. Gilmore, V. Chen, L. Young, E. Merriman, J. Curnow, J. Joseph, J.Y. Tiao, J. Chih, S. McRae, …

Research and practice in thrombosis and haemostasis, Vol.7(5), 100196

2023

DOI: https://doi.org/10.1016/j.rpth.2023.100196

Files and links (1)

pdf

Published1.13 MBDownload View

Open Access CC BY-NC-ND V4.0

Abstract

anticoagulants

coagulation

dabigatran

hemorrhage

hemostatics

Background Restoring haemostasis in patients on oral anticoagulants (OAC) presenting with major haemorrhage (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 haemostatic management in patients on VKA compared to DOACs. Methods A multicentre observational study evaluated the variation in laboratory testing, haemostatic management, mortality, and hospital length of stay (LOS) in patients on VKA or DOACs presenting with MH or urgent haemostatic restoration (UHR). Results Of the 1194 patients analysed, 783 had MH (61% VKA), and 411 required UHR before surgery (56% VKA). Compared to the INR (97.6%), plasma DOAC levels were measured less frequently (<45%), and the time 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 (<50ng/ml) was found in up to 19% of patients. There was a poor relationship between plasma DOAC level and the usage of a haemostatic agent. When compared to VKA (96.5%) or dabigatran (93.7%) patients, fewer FXa inhibitor patients (75.5%) received a pro-haemostatic reversal agent. The overall 30-day mortality for MH (mean 17.8%) and LOS (median 8.7 days) was similar between VKA and DOAC patients. Conclusions In DOAC patients, when compared to VKA, plasma DOAC levels are measured less frequently than the INR and have a poor relationship to administering a haemostatic reversal agent. In addition, following MH, mortality and LOS are similar between VKA and DOAC patients.

Details

Title: Direct oral anticoagulants or Vitamin K antagonists in emergencies: comparison of management in an observational study
Authors/Creators: R.I. Baker - Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics
G. Gilmore - Western Australia Centre for Thrombosis and Haemostasis, Murdoch University, Perth, Australia
V. Chen - The University of Sydney
L. Young - Auckland City Hospital
E. Merriman - North Shore Hospital
J. Curnow - Westmead Hospital, Sydney, Australia
J. Joseph - Saint Vincent's Catholic Medical Center
J.Y. Tiao - Murdoch University
J. Chih - Curtin School of Population Health, Perth, Australia
S. McRae - Royal Adelaide Hospital
P. Harper - Palmerston North Hospital, New Zealand
C.W. Tan - Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
T. Brighton - Prince of Wales Hospital
G. Royle - Middlemore Hospital
A. Hugman - St George Hospital Sydney, Australia
G. Hankey - Harry Perkins Research Institute, University of Western Australia, Perth, Australia
H. Crowther - Blacktown Hospital, Sydney Australia
J. Boey - Flinders University
A. Gallus - Flinders Medical Centre, Flinders University, Adelaide, Australia
P. Campbell - Geelong Hospital
H. Tran - Alfred Hospital, Melbourne, Australia
V. Chen - Concord Repatriation General Hospital
L. Young - Auckland City Hospital
E. Merriman - North Shore Hospital
J. Curnow - Westmead Hospital
A. Gallus - Flinders Medical Centre
J. Boey - Flinders Medical Centre
Chee Wee Tan - Royal Adelaide Hospital
S. McRae - Royal Adelaide Hospital
A. Hugman - St George Hospital
J. Joseph - St Vincent Hospital
P. Harper - Palmerston North Hospital
T. Brighton - Prince of Wales Hospital
G. Royle - Middlemore Hospital
H. Crowther - Blacktown & Mount Druitt Hospital
H. Tran - Alfred Hospital
P. Campbell - Geelong Hospital
R. Baker - Hollywood Private Hospital
Thrombosis and Haemostasis Society of Australia and New Zealand ARES Study Collaborative
Publication Details: Research and practice in thrombosis and haemostasis, Vol.7(5), 100196
Publisher: Elsevier Inc. on behalf of International Society on Thrombosis and Haemostasis.
Identifiers: 991005579168507891
Murdoch Affiliation: Western Australian Centre for Thrombosis and Haemostasis; Centre for Molecular Medicine and Innovative Therapeutics
Language: English
Resource Type: Journal article

Metrics

54 File views/ downloads

210 Record Views

4 Times Cited - Web of Science

InCites Highlights

These are selected metrics from InCites Benchmarking & Analytics tool, related to this output

Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.94 Cardiac Arrhythmia; 1.94.95 Atrial Fibrillation Management
Web Of Science research areas: Hematology; Peripheral Vascular Disease
ESI research areas: Clinical Medicine