TY - JOUR
T1 - Anticoagulation in emergency general surgery
T2 - Who bleeds more? The EAST multicenter trials ACES study
AU - O'Meara, Lindsay
AU - Zhang, Ashling
AU - Baum, Jeffrey N.
AU - Cooper, Amanda
AU - Decker, Cassandra
AU - Schroeppel, Thomas
AU - Cai, Jenny
AU - Cullinane, Daniel C.
AU - Catalano, Richard D.
AU - Bugaev, Nikolay
AU - LeClair, Madison J.
AU - Feather, Cristina
AU - McBride, Katherine
AU - Sams, Valerie
AU - Leung, Pak Shan
AU - Olafson, Samantha
AU - Callahan, Devon S.
AU - Posluszny, Joseph
AU - Moradian, Simon
AU - Estroff, Jordan
AU - Hochman, Beth
AU - Coleman, Natasha L.
AU - Goldenberg-Sandau, Anna
AU - Nahmias, Jeffry
AU - Rosenbaum, Kathryn
AU - Pasley, Jason D.
AU - Boll, Lindsay
AU - Hustad, Leah
AU - Reynolds, Jessica
AU - Truitt, Michael
AU - Vesselinov, Roumen
AU - Ghneim, Mira
N1 - Publisher Copyright:
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - Background: While direct oral anticoagulant (DOAC) use is increasing in the Emergency General Surgery (EGS) patient population, our understanding of their bleeding risk in the acute setting remains limited. Therefore, the objective of this study was to determine the prevalence of perioperative bleeding complications in patients using DOACs versus warfarin andAP therapy requiring urgent/emergent EGS procedures (EGSPs). Methods: This was a prospective observational trial, conducted between 2019 and 2022, across 21 centers. Inclusion criteriawere 18 years or older, DOAC,warfarin/AP usewithin 24 hours of requiring an urgent/emergent EGSP.Demographics, preoperative, intraoperative, and postoperative data were collected. ANOVA, χ2, and multivariable regression models were used to conduct the analysis. Results: Of the 413 patients enrolled in the study, 261 (63%) reported warfarin/AP use and 152 (37%) reported DOAC use. Appendicitis and cholecystitis were the most frequent indication for operative intervention in the warfarin/AP group (43.4% vs. 25%, p = 0.001). Small bowel obstruction/abdominalwall herniaswere themain indication for operative intervention in theDOAC group (44.7%vs. 23.8%, p = 0.001). Intraoperative, postoperative, and perioperative bleeding complications and in-hospital mortality were similar between the two groups. After adjusting for confounders, a history of chemotherapy (odds ratio [OR], 4.3; p = 0.015) and indication for operative intervention including occlusivemesenteric ischemia (OR, 4.27; p = 0.016), nonocclusivemesenteric ischemia (OR, 3.13; p = 0.001), and diverticulitis (OR, 3.72; p = 0.019) were associated with increased perioperative bleeding complications. The need for an intraoperative transfusion (OR, 4.87; p < 0.001), and intraoperative vasopressors (OR, 4.35; p = 0.003) were associated with increased in-hospital mortality. Conclusion: Perioperative bleeding complications andmortality are impacted by the indication for EGSPs and patient's severity of illness rather than a history of DOAC or warfarin/AP use. Therefore, perioperative management should be guided by patient physiology and indication for surgery rather than the concern for recent antiplatelet or anticoagulant use.
AB - Background: While direct oral anticoagulant (DOAC) use is increasing in the Emergency General Surgery (EGS) patient population, our understanding of their bleeding risk in the acute setting remains limited. Therefore, the objective of this study was to determine the prevalence of perioperative bleeding complications in patients using DOACs versus warfarin andAP therapy requiring urgent/emergent EGS procedures (EGSPs). Methods: This was a prospective observational trial, conducted between 2019 and 2022, across 21 centers. Inclusion criteriawere 18 years or older, DOAC,warfarin/AP usewithin 24 hours of requiring an urgent/emergent EGSP.Demographics, preoperative, intraoperative, and postoperative data were collected. ANOVA, χ2, and multivariable regression models were used to conduct the analysis. Results: Of the 413 patients enrolled in the study, 261 (63%) reported warfarin/AP use and 152 (37%) reported DOAC use. Appendicitis and cholecystitis were the most frequent indication for operative intervention in the warfarin/AP group (43.4% vs. 25%, p = 0.001). Small bowel obstruction/abdominalwall herniaswere themain indication for operative intervention in theDOAC group (44.7%vs. 23.8%, p = 0.001). Intraoperative, postoperative, and perioperative bleeding complications and in-hospital mortality were similar between the two groups. After adjusting for confounders, a history of chemotherapy (odds ratio [OR], 4.3; p = 0.015) and indication for operative intervention including occlusivemesenteric ischemia (OR, 4.27; p = 0.016), nonocclusivemesenteric ischemia (OR, 3.13; p = 0.001), and diverticulitis (OR, 3.72; p = 0.019) were associated with increased perioperative bleeding complications. The need for an intraoperative transfusion (OR, 4.87; p < 0.001), and intraoperative vasopressors (OR, 4.35; p = 0.003) were associated with increased in-hospital mortality. Conclusion: Perioperative bleeding complications andmortality are impacted by the indication for EGSPs and patient's severity of illness rather than a history of DOAC or warfarin/AP use. Therefore, perioperative management should be guided by patient physiology and indication for surgery rather than the concern for recent antiplatelet or anticoagulant use.
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U2 - 10.1097/TA.0000000000004042
DO - 10.1097/TA.0000000000004042
M3 - Article
C2 - 37349868
AN - SCOPUS:85172034338
SN - 2163-0755
VL - 95
SP - 510
EP - 515
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 4
ER -