Retrospective analysis of direct oral anticoagulation hold recommendation adherence for gastrointestinal procedures by an outpatient anticoagulation clinic

Background

Anticoagulant medications can cause harm to patients in the periprocedural setting if managed inappropriately. Recent guidelines have attempted to standardize recommendations for anticoagulation management, but patients may still experience harm if these recommendations are not followed.

Objectives

This study aimed to compare the hold recommendations given by an outpatient anticoagulation clinic with the actual duration that patients held their anticoagulants periprocedurally. Additional outcomes included time between hold duration communication and procedure, significant bleeding events, thromboembolic events, and death within 30 days of the procedure.

Methods

This was a retrospective chart review of patients taking a direct oral anticoagulant (DOAC) who underwent an elective gastrointestinal procedure between April 30, 2021, and April 30, 2023. Data collection included adherence to periprocedural hold recommendations, length of time between communication of instructions and procedure, number of procedure cancellations or reschedules, and rates of 30-day bleeding events, thromboembolic events, and death.

Results

Two hundred charts were reviewed and 118 patients (59%) followed the preprocedure hold recommendations given by the anticoagulation clinic. The mean time between communicating recommendations to a patient and the date of the procedure was 56.6 days. No procedures were cancelled or rescheduled owing to DOAC mismanagement. There were 5 bleeding events and no clotting events or deaths within 30 days of the procedure. Of the patients who experienced a bleeding event, none held their anticoagulant for a shorter duration than recommended.

Conclusion

This study revealed nonideal patient adherence to guideline-based periprocedural hold recommendations for DOACs. Despite this, no procedures were delayed or cancelled, and limited safety events occurred. The length of time between communication of the recommendation and the date of the procedure was long and may explain low patient adherence. Additional studies are necessary to determine periprocedural adherence and potential adverse outcomes for other surgical procedures.