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Background:

Patients with atrial fibrillation (AF) who are on anticoagulant therapy often require a surgery/procedure. We compared outcomes in edoxaban- and warfarin-treated patients who did or did not interrupt anticoagulation perioperatively.

Methods:

We studied consecutive patients in ENGAGE, a randomized double-blind trial comparing edoxaban (30 and 60 mg QD) with warfarin for stroke prevention in AF, who had a first surgery/procedure. Anticoagulation interruption was defined as stopping study drug 4-10 days pre-surgery; non-interruption was defined as study drug continued or stopped ≤3 days pre-surgery. Period of observation: surgery date until 30 days post-surgery. Patients with stroke/systemic embolism (SSE) or major bleed (MB) in the week pre-surgery were excluded. Adverse outcomes assessed: SSE, MB, death. The Chi-square test compared outcomes in the 3 treatment groups.

Results:

3,116 patients interrupted study drug 4-10 days pre-surgery and 4,077 continued study drug or stopped ≤3 days pre-surgery. Baseline clinical characteristics and CHADS2, CHA2DS2VASc, HAS-BLED scores did not differ significantly across the three treatment groups (data not shown). Adverse outcomes are shown according to perioperative management: anticoagulation interrupted or not uninterrupted.

  • Adverse Outcome, % (n/N)

Patients Requiring Surgery/Procedure by Treatment AllocationP-value
Adverse Outcome, % (n/N)Edoxaban 30 mgEdoxaban 60 mgP-value
  • SSE

  • - interrupted

  • - uninterrupted

  • 0.9 (9/1041)

  • 0.9 (12/1405)

  • 0.5 (5/1012)

  • 0.7 (10/1367)

  • 0.53

  • 0.51

  • MB

  • - interrupted

  • - uninterrupted

  • 1.1 (11/1041)

  • 2.4 (34/1405)

  • 1.2 (12/1012)

  • 2.6 (35/1367)

  • 1.0 (11/1063)

  • 3.6 (47/1305)

  • 0.94

  • 0.13

  • Death

  • - interrupted

  • - uninterrupted

  • 1.2 (12/1041)

  • 1.3 (18/1405)

  • 1.0 (10/1012)

  • 1.5 (20/1367)

  • 1.2 (13/1063)

  • 1.5 (20/1305)

  • 0.87

  • 0.85

Conclusion:

In patients requiring a surgery/procedure perioperative adverse outcomes were similar in edoxaban- and warfarin-treated patients regardless of whether anticoagulation was interrupted or not.

Footnotes

Poster Contributions

Poster Hall B1

Saturday, March 14, 2015, 3:45 p.m.-4:30 p.m.

Session Title: Cerebrovascular Disease and Stroke: Novel Insights

Abstract Category: 45. Vascular Medicine: Non Coronary Arterial Disease

Presentation Number: 1155-339