Perioperative Management of Oral Anticoagulation: A Real-World Observational Study

Aims:Using a retrospective study, we evaluated: the risk of thromboembolism and bleeding following the perioperative management of oral anticoagulants (OACs) and the adherence to the guidelines by the clinicians involved. Methods:Six hundred procedures, 120 for each OAC were collected from a Central Tuscany Surgery Department database. The endpoints were:the 30-days rate of arterial, venous thrombotic events and bleedings, classified by ISTH, and their association with adherence to EHRA guidelines. Results: Three hundreds and seventy one procedures(61%) were at high risk of bleeding. Until 30 days of follow-up, thrombotic events occurred in 4 patients, 7% total bleedings;12.8% of bleedings occurred in inappropriate heparin bridging and 5.7% in patients without bridging (p <.016). Four hundred and forty two (73.7%) procedures were performed in complete adherence to guidelines. At the multivariate analysis inappropriate bridging (HR=2.3;95% CI 1.1-4.7; p=.021) and urologic interventions (HR=2.3;95% CI 1.2-4.4;p=.01) were independent risk factors for bleeding events. Conclusions: Bleedings were significantly correlated with inappropriate heparin bridging even if occurred also in correct management of OACs, being related to the major surgery itself.