Managing DOACs in Patients with Atrial Fibrillation Who Are Undergoing Endoscopy

A standardized approach was associated with low rates of thromboembolism and major bleeding.

In the multicenter PAUSE study (NEJM JW Gen Med Sep 1 2019 and JAMA Intern Med 2019; 179:1469), researchers attempted to provide a safe and feasible approach to periprocedural management of direct-acting oral anticoagulants (DOACs; i.e., apixaban, rivaroxaban, or dabigatran) for patients with atrial fibrillation (AF). This study defined DOAC-specific hold and resumption intervals without preoperative heparin bridging or coagulation testing. Yet, discrepancies in periprocedural DOAC recommendations remain among current guidelines.

This PAUSE subgroup analysis involved 556 adult DOAC-treated patients with AF who underwent endoscopy (colonoscopy, gastroscopy, or both). Investigators assessed risks associated with DOAC interruption 1 day before …

Reviewing Author

Andrew S. Parsons, MD, MPH

Disclosures

Consultant/Advisory BoardNEJM Healer Advisory Group; Aquifer Clinical Excellence; NBME Clinical Reasoning

Grant/Research SupportSouthern Group on Educational Affairs (SGEA)

Editorial BoardsDiagnosis

Leadership Positions in Professional SocietiesUndergraduate Medical Education (UME) Section Chair, Southern Group on Educational Affairs (SGEA); Chair of Early Career Physicians, American College of Physicians (ACP), Virginia Chapter

Andrew S. Parsons, MD, MPH

Disclosures

Consultant/Advisory BoardNEJM Healer Advisory Group; Aquifer Clinical Excellence; NBME Clinical Reasoning

Grant/Research SupportSouthern Group on Educational Affairs (SGEA)

Editorial BoardsDiagnosis

Managing DOACs in Patients with Atrial Fibrillation Who Are Undergoing Endoscopy

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Reviewing Author