Direct oral anticoagulants in patients undergoing spine surgery.

Direct oral anticoagulants in patients undergoing spine surgery.

World Neurosurg. 2019 Feb 15;:

Authors: Croci DM, Dalolio M, Guzman R, Mariani L, Schaeren S, Kamenova M, Soleman J

Abstract
OBJECT: Despite the increasing use of DOACs, guidelines for their perioperative use in spine surgery are still lacking. The main goal of our study was to analyze the occurrence of postoperative bleeding events and possible confounders in patients treated with DOACs who undergo spine surgery.
MATERIAL AND METHODS: Out of 2777 patients undergoing spine surgery at our institution, 82 (2.9%) were treated with DOACs. The primary endpoint was postoperative bleeding events. Secondary outcome measures were postoperative thromboembolic events and anemia, hematological findings, perioperative PRBC substitution, operation and hospitalization time, morbidity, and mortality. A sub-analysis of possible confounders affecting the rates of bleeding was performed as well. Additionally, the correlation of bleeding event rates and the pre- and postoperative discontinuation of DOACs was analyzed.
RESULTS: Overall postoperative bleeding events rate was 4.9% (n=4). Preoperative DOACs discontinuation time of less than 24 hours increased significantly the rate of perioperative PRBC substitution (p=.007). Treatment with concomitant blood thinners showed a trend towards higher incidence of bleeding events (p=.066), while preexisting kidney failure increased significantly the rates of postoperative anemia (p=.014). The rate of postoperative thromboembolic events was 4.9 % (n=4), all of which occurred with DOACs resumption >72 hours postoperatively.
CONCLUSION: Short preoperative discontinuation time of DOACs, even < 24 hours, might be justified, considering an increased risk of perioperative PRBC substitution. Care should be taken with patients treated with concomitant blood thinners and those with preexisting kidney disease. Postoperative DOACs resumption >72 hours might increase the risk of thromboembolic events.

PMID: 30776515 [PubMed - as supplied by publisher]

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