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Should Procedures or Patients Be Safe? Bias in Recommendations for Periprocedural Discontinuation of Anticoagulation

Published on Sep 1, 2018
· DOI :10.1016/j.mayocp.2018.05.013
Andrew J. Doorey8
Estimated H-index: 8
(Christiana Care Health System),
William S. Weintraub (MedStar Health), J. Sanford Schwartz61
Estimated H-index: 61
(UPenn: University of Pennsylvania)
Abstract
  • References (16)
  • Citations (0)
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References16
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#1Ruben D. AcostaH-Index: 20
#2Neena Susan AbrahamH-Index: 32
Last. John M. DeWittH-Index: 45
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Ruben D. Acosta, MD, Neena S. Abraham, MD, MSCE, FASGE (invited content expert, ad-hoc member), Vinay Chandrasekhara, MD, Krishnavel V. Chathadi, MD, Dayna S. Early, MD, FASGE, Mohamad A. Eloubeidi, MD, MHS, FASGE, John A. Evans, MD, Ashley L. Faulx, MD, FASGE, Deborah A. Fisher, MD, MHS, FASGE, Lisa Fonkalsrud, BSN, RN, CGRN, Joo Ha Hwang, MD, PhD, FASGE, Mouen A. Khashab, MD, Jenifer R. Lightdale, MD, MPH, FASGE, V. Raman Muthusamy, MD, FASGE, Shabana F. Pasha, MD, John R. Saltzman, MD, FASGE,...
147 CitationsSource
#1Pablo Alonso-Coello (Cochrane Collaboration)H-Index: 50
#2Victor Manuel Montori (Mayo Clinic)H-Index: 108
Last. Gordon H. Guyatt (MUMC: McMaster University Medical Centre)H-Index: 201
view all 15 authors...
Background Exploration of values and preferences in the context of anticoagulation therapy for atrial fibrillation (AF) remains limited. To better characterize the distribution of patient and physician values and preferences relevant to decisions regarding anticoagulation in patients with AF, we conducted interviews with patients at risk of developing AF and physicians who manage patients with AF. Methods We interviewed 96 outpatients and 96 physicians in a multicenter study and elicited the max...
34 CitationsSource
#1Michael J. Wahl (Christiana Care Health System)H-Index: 2
#2Andres Pinto (Case Western Reserve University)H-Index: 6
Last. Rajesh V. Lalla (University of Connecticut Health Center)H-Index: 31
view all 4 authors...
In a literature review, the incidence and morbidity of bleeding complications after dental surgery in anticoagulated patients was compared with embolic complications when anticoagulation was interrupted. Over 99% of anticoagulated patients had no postoperative bleeding that required more than local hemostatic measures. Of more than 5431 patients undergoing more than 11,381 surgical procedures, with many patients at higher than present therapeutic intenational normalized ratio (INR) levels, only ...
25 CitationsSource
#1Luigi Di Biase (University of Foggia)H-Index: 55
#2J. David BurkhardtH-Index: 53
Last. Andrea Natale (Stanford University)H-Index: 102
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Background— Periprocedural thromboembolic and hemorrhagic events are worrisome complications of catheter ablation for atrial fibrillation (AF). The periprocedural anticoagulation management could play a role in the incidence of these complications. Although ablation procedures performed without warfarin discontinuation seem to be associated with lower thromboembolic risk, no randomized study exists. Methods and Results— This was a prospective, open-label, randomized, parallel-group, multicenter ...
226 CitationsSource
#1Akira HoriuchiH-Index: 26
#2Yoshiko Nakayama (Shinshu University)H-Index: 21
Last. David Y. Graham (BCM: Baylor College of Medicine)H-Index: 126
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Background The bleeding risk after cold snare polypectomy in anticoagulated patients is not known. Objective To compare the bleeding risk after cold snare polypectomy or conventional polypectomy for small colorectal polyps in anticoagulated patients. Design Prospective randomized controlled study. Setting Municipal hospital in Japan. Interventions Anticoagulated patients with colorectal polyps up to 10 mm in diameter were enrolled. Patients were randomized to polypectomy with either cold snare t...
123 CitationsSource
#1David H. BirnieH-Index: 43
#2Jeff S. HealeyH-Index: 62
Last. Vidal EssebagH-Index: 30
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BackgroundMany patients requiring pacemaker or implantable cardioverter–defibrillator (ICD) surgery are taking warfarin. For patients at high risk for thromboembolic events, guidelines recommend bridging therapy with heparin; however, case series suggest that it may be safe to perform surgery without interrupting warfarin treatment. There have been few results from clinical trials to support the safety and efficacy of this approach. MethodsWe randomly assigned patients with an annual risk of thr...
281 CitationsSource
#1Jeff S. HealeyH-Index: 62
#2John W. EikelboomH-Index: 93
Last. Michael D. EzekowitzH-Index: 75
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BACKGROUND: Dabigatran reduces ischemic stroke in comparison with warfarin; however, given the lack of antidote, there is concern that it might increase bleeding when surgery or invasive procedures are required. METHODS AND RESULTS: The current analysis was undertaken to compare the periprocedural bleeding risk of patients in the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial treated with dabigatran and warfarin. Bleeding rates were evaluated from 7 days before until 30...
311 CitationsSource
#1Jeff S. HealeyH-Index: 62
#2John W. EikelboomH-Index: 93
Last. Michael D. EzekowitzH-Index: 75
view all 13 authors...
Background—Dabigatran reduces ischemic stroke in comparison with warfarin; however, given the lack of antidote, there is concern that it might increase bleeding when surgery or invasive procedures are required. Methods and Results—The current analysis was undertaken to compare the periprocedural bleeding risk of patients in the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial treated with dabigatran and warfarin. Bleeding rates were evaluated from 7 days before until 30 d...
262 CitationsSource
#1James D. Douketis (McMaster University)H-Index: 71
#2Alex C. Spyropoulos (UR: University of Rochester)H-Index: 19
Last. Regina KunzH-Index: 39
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Background This guideline addresses the management of patients who are receiving anticoagulant or antiplatelet therapy and require an elective surgery or procedure. Methods The methods herein follow those discussed in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines article of this supplement. Results I...
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#1Daniel M. Witt (KP: Kaiser Permanente)H-Index: 27
#2Thomas Delate (CU: University of Colorado Boulder)H-Index: 23
Last. W. G. RectorH-Index: 1
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Summary. Background and aims: To assess the effect of warfarin anticoagulation therapy (AC) on the incidence of colon bleeding after elective colonoscopy with polypectomy and to identify independent predictors of post-polypectomy colon bleeding. Methods: This was a retrospective cohort analysis. Patients interrupting warfarin AC therapy for polypectomy (AC group) were matched on age (± 3 years) with up to two patients who underwent polypectomy but were not receiving AC (non-AC group). Data were ...
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