Safety of apixaban and rivaroxaban compared to warfarin after cardiac surgery

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2022-12-07 DOI:10.1111/jocs.17203

Kushal D. Naik PharmD, MBA, Bryan A. Whitson MD, PhD, Eric M. McLaughlin MS, Nancy B. Matre MS, Alan J. Rozycki PharmD, BCCCP

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引用次数: 1

Abstract

Background

Direct oral anticoagulants (DOACs) are frequently prescribed for the management of atrial fibrillation and venous thrombosis. There is a lack of published data on the utilization of DOACs in individuals who have undergone recent cardiac surgery. The purpose of this study was to evaluate the safety and efficacy of apixaban and rivaroxaban compared to warfarin in patients postcardiac surgery.

Methods

In this retrospective cohort study, patients were separated into a DOAC cohort or a warfarin cohort based on the agent they received after cardiac surgery. Patients could be included if they were ≥18 years of age and received or were discharged on either rivaroxaban, apixaban, or warfarin within 7 days after cardiac surgery. The primary outcome for the study was the rate of International Society on Thrombosis and Hemostasis (ISTH) major bleeding during hospitalization and for 30 days following discharge or until first follow-up appointment.

Results

There were a total of 194 patients included in the analysis, 97 in the DOAC cohort and 97 in the warfarin cohort. Four patients (4.1%) in the DOAC group experienced ISTH major bleeding, while 2 patients (2.1%) in the warfarin cohort experienced ISTH major bleeding (p = 0.68). No patients in the DOAC cohort experienced a thrombotic event, whereas 2 patients (2.1%) in the warfarin cohort experienced a thrombotic complication (p = 0.5).

Conclusion

Apixaban and rivaroxaban demonstrated similar safety when compared to a matched cohort of warfarin patients. Larger prospective randomized studies are needed to confirm these findings.

Abstract Image

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心脏手术后阿哌沙班和利伐沙班与华法林的安全性比较

背景直接口服抗凝剂(DOACs)经常用于房颤和静脉血栓的治疗。关于近期接受过心脏手术的患者使用DOACs的公开数据缺乏。本研究的目的是评价阿哌沙班和利伐沙班与华法林在心脏手术后患者中的安全性和有效性。方法在这项回顾性队列研究中，患者根据心脏手术后使用的药物分为DOAC组和华法林组。如果患者年龄≥18岁，并且在心脏手术后7天内接受或出院使用利伐沙班、阿哌沙班或华法林，则可以纳入研究。该研究的主要结局是国际血栓和止血学会(ISTH)在住院期间和出院后30天或直到第一次随访预约的大出血率。结果共纳入194例患者，DOAC组97例，华法林组97例。DOAC组出现ISTH大出血4例(4.1%)，华法林组出现ISTH大出血2例(2.1%)(p = 0.68)。DOAC组中没有患者发生血栓事件，而华法林组中有2例患者(2.1%)发生血栓并发症(p = 0.5)。结论阿哌沙班和利伐沙班在华法林患者的匹配队列中表现出相似的安全性。需要更大规模的前瞻性随机研究来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.