Study Sheds Light on Stopping and Resuming DOACs in Afib Patients Undergoing Surgery

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

A standardized strategy for interrupting direct-acting oral anticoagulant (DOAC) therapy — without the need for heparin bridging or preoperative coagulation function testing — could help simplify the management of patients with atrial fibrillation undergoing elective surgery, according to a JAMA Internal Medicine study.

The study included over 3000 adults with atrial fibrillation who were scheduled for a procedure that required DOAC interruption. Per the protocol, the DOAC was generally stopped for the 1 or 2 days before the procedure (depending on the procedure's level of bleeding risk), and then was resumed 1 to 3 days after the procedure (again, depending on bleeding risk).

At 30 days, rates of the two primary clinical outcomes — major bleeding and arterial thromboembolism — were low.

Dr. Thomas Schwenk of NEJM Journal Watch General Medicine examines these findings at the first link below. Have a look.