Clinical Course and Management of Patients with Emergency Surgery Treated with Direct Oral Anticoagulants or Vitamin K Antagonists-Results of the German Prospective RADOA-Registry

Jana Last; Eva Herrmann; Ingvild Birschmann; Simone Lindau; Stavros Konstantinides; Oliver Grottke; Ulrike Nowak-Göttl; Barbara Zydek; Christian von Heymann; Ariane Sümnig; Jan Beyer-Westendorf; Sebastian Schellong; Patrick Meybohm; Andreas Greinacher; Edelgard Lindhoff-Last; RADOA-Registry Investigators

doi:10.3390/jcm13010272

Clinical Course and Management of Patients with Emergency Surgery Treated with Direct Oral Anticoagulants or Vitamin K Antagonists-Results of the German Prospective RADOA-Registry

J Clin Med. 2024 Jan 3;13(1):272. doi: 10.3390/jcm13010272.

Authors

Jana Last^{1

2}, Eva Herrmann³, Ingvild Birschmann⁴, Simone Lindau⁵, Stavros Konstantinides⁶, Oliver Grottke⁷, Ulrike Nowak-Göttl⁸, Barbara Zydek^{1

9}, Christian von Heymann¹⁰, Ariane Sümnig¹¹, Jan Beyer-Westendorf¹², Sebastian Schellong¹³, Patrick Meybohm¹⁴, Andreas Greinacher¹¹, Edelgard Lindhoff-Last^{1

9}; RADOA-Registry Investigators

Affiliations

¹ Coagulation Research Centre Bethanien Hospital, 63089 Frankfurt, Germany.
² Deutsches Herzzentrum der Charité (DHZC) Berlin, Department of Cardiology, Angiology and Intensive Care Medicine, Charité Berlin, 12203 Berlin, Germany.
³ Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, 60596 Frankfurt, Germany.
⁴ Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Centre, Ruhr University, 44801 Bochum, Germany.
⁵ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, 60596 Frankfurt, Germany.
⁶ Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, 55122 Mainz, Germany.
⁷ Department of Anaesthesiology, RWTH Aachen University Hospital, 52062 Aachen, Germany.
⁸ Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Centre, University Hospital, Kiel-Lübeck, 24105 Kiel, Germany.
⁹ Coagulation Centre at the Cardiology Angiology Centre Bethanien Hospital (CCB), 63089 Frankfurt, Germany.
¹⁰ Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, 10249 Berlin, Germany.
¹¹ Institute for Transfusions Medicine, Universitätsmedizin Greifswald, 17489 Greifswald, Germany.
¹² Department of Medicine 1, Division of Thrombosis & Hemostasis, Dresden University Clinic, 01307 Dresden, Germany.
¹³ Medical Department 2, Municipal Hospital, 01129 Dresden, Germany.
¹⁴ Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080 Wuerzburg, Germany.

Abstract

(1) Background: The clinical management of anticoagulated patients treated with direct oral anticoagulants (DOAC) or Vitamin K antagonists (VKA) needing emergency surgery is challenging. (2) Methods: The prospective German RADOA registry investigated treatment strategies in DOAC- or VKA-treated patients needing emergency surgery within 24 h after admission. Effectiveness was analysed by clinical endpoints including major bleeding. Primary observation endpoint was in hospital mortality until 30 days after admission. (3) Results: A total of 78 patients were included (DOAC: 44; VKA: 34). Median age was 76 years. Overall, 43% of the DOAC patients and 79% of the VKA patients were treated with prothrombin complex concentrates (PCC) (p = 0.002). Out of the DOAC patients, 30% received no hemostatic treatment compared to 3% (1/34) of the VKA patients (p = 0.002), and 7% of the DOAC patients and 21% of the VKA patients developed major or clinically relevant non-major bleeding at the surgical site (p = 0.093). In-hospital mortality was 13% with no significant difference between the two treatment groups (DOAC: 11%, VKA: 15%; p > 0.20). (4) Conclusions: The 30-day in-hospital mortality rate was comparable between both patient groups. VKA patients required significantly more hemostatic agents than DOAC patients in the peri- and postoperative surgery period.

Keywords: direct oral anticoagulants; emergency surgery; major bleeding; prothrombin complex concentrate; vitamin K antagonists.

Grants and funding

This work was funded by Bayer, Bristol-Myers Squibb/Pfizer, DAIICHI Sankyo, and CSL Behring. The funders had no role in the design of the registry, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.