Perioperative medicine & outcomes
Perioperative Management of Vitamin K Antagonists and Direct Oral Anticoagulants: A Systematic Review and Meta-analysis
Authors' conclusion
The certainty in the evidence supporting the perioperative management of anticoagulants remains limited.
Study context
- Population
- Patients on long-term vitamin K agonist (VKA) or direct oral anticoagulant (DOAC) requiring elective surgery or procedures
- Comparison
- Perioperative VKA or DOAC management strategies
- Outcome
- Major bleeding / bleeding
Methodological detailsevidence review for American College of Chest Physicians guidelines, Literature search of multiple databases from inception through July 16, 2020; meta-analyses where appropriate
- Evidence review for American College of Chest Physicians guidelines
- Literature search of multiple databases from inception through July 16, 2020; meta-analyses where appropriate
Pooled result
As reported in the abstract
- VKA (warfarin), elective noncardiac surgery: shorter (< 3 days) VKA interruption associated with increased risk of major bleeding
- VKA interruption: heparin bridging (mostly LMWH) associated with statistically significant increased risk of major bleed (very low certainty of evidence)
- Continuing DOACs vs interruption 1 to 4 days before surgery may be associated with higher bleeding risk, in some but not all studies
- DOAC interruption: bridging with LMWH may be associated with statistically significant increased risk of bleeding (low certainty of evidence)
Original publication
Perioperative Management of Vitamin K Antagonists and Direct Oral Anticoagulants: A Systematic Review and Meta-analysis. Chest. Published 1 December 2022. doi:10.
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