No differences in bleeding, thromboembolic events with DOACs vs. warfarin after surgery
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Patients who received apixaban or rivaroxaban after cardiac surgery were no more likely to experience major bleeding or thromboembolic events compared with patients who received warfarin after surgery, data from a single-center study show.
“Landmark studies of the major direct oral anticoagulant agents were not designed to study outcomes in cardiac surgery patients,” Alan J. Rozycki, PharmD, BCCCP, of the department of pharmacy at Ohio State University Wexner Medical Center, and colleagues wrote in the study background. “Due to the limitations with existing data, questions remain about the safety and efficacy of initiating apixaban or rivaroxaban during the index hospitalization in patients who undergo cardiac surgery.”
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In a retrospective study, Rozycki and colleagues analyzed data from 194 adults who underwent cardiac surgery between January 2013 and October 2021 and were discharged on or administered at least one dose of rivaroxaban (Xarelto, Janssen/Bayer), apixaban or warfarin. Patients were stratified by use of direct oral anticoagulants (DOACs; n = 97; median age, 64 years) or warfarin (n = 97; median age, 67 years). The primary outcome was the rate of International Society on Thrombosis and Haemostasis (ISTH) major bleeding during hospitalization and for 30 days after discharge or until first follow‐up appointment.
“We matched on type of procedure, concomitant antiplatelets, indications of anticoagulation, and on vs. off pump for CABG procedures,” the researchers wrote. “Using this approach allowed important confounders to be controlled for that could predispose patients to bleeding or thrombosis. Furthermore, in this study all patients were started on an oral anticoagulant during the index hospitalization of cardiac surgery and within 7 days of the cardiac procedure.”
The findings were published in the Journal of Cardiac Surgery.
Within the cohort, four patients (4.1%) in the DOAC group and two patients in the warfarin group (2.1%) experienced ISTH major bleeding (P = .68). No patients in the DOAC cohort experienced a thrombotic event, whereas two patients (2.1%) in the warfarin cohort experienced a thrombotic complication (P = .5).
“There was no statistically significant difference in ISTH major bleeding or thromboembolic events between the two groups,” the researchers wrote. “The promising results of this study highlight the need for a large prospective randomized clinical trial to definitively make conclusions about the safety of apixaban and rivaroxaban when compared to warfarin in patients who have undergone recent cardiac surgery.”
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