PB1080 - Clinical Course and management of patients with emergency surgeries treated with direct oral anticoagulants or vitamin K antagonists – Results of the German prospective RADOA-registry

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Jana Last, MD

MD, Resident
Deutsches Herzzentrum der Charité (DHZC) Berlin, Germany
Berlin, Berlin, Germany

Co-Author(s)

EL

Edelgard Lindhoff-Last

MD, Head of Coagulation Centre and Head of Coagulation Research Centre
Cardiology Angiology Centre Bethanien Hospital (CCB), Frankfurt Germany
Frankfurt, Hessen, Germany
IB

Ingvild Birschmann

Senior Physician
Herz- und Diabeteszentrum Nordrhein-Westfalen
Bad Oeynhausen, Nordrhein-Westfalen, Germany
SL

Simone Lindau

MD, Resident
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
Frankfurt, Hessen, Germany
SK

Stavros Konstantinides

MD, PhD
Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University
Mainz, Rheinland-Pfalz, Germany
OG

Oliver Grottke, MD, PhD

Consultant
Department of Anaesthesiology, RWITH Aachen University Hospital, Aachen, Germany
Aachen, Nordrhein-Westfalen, Germany
UN

Ulrike Nowak-Göttl

MD, Head of Institute of Clinical Chemistry,
Thrombosis & Haemostasis Treatment Centre, University Hospital Schleswig-Holstein, Germany
Kiel, Schleswig-Holstein, Germany
BZ

Barbara Zydek

MD, Senior physician
Coagulation Research Centre Bethanien Hospital, Frankfurt, Germany
Frankfurt, Hessen, Germany
Cv

Christian von Heymann

MD, Head of
Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
Berlin, Berlin, Germany
Jan Beyer-Westendorf, MD,PhD

Head of Division "Thrombosis and Hemostasis", Head of „Thrombosis Research“
University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Division of Hematology and Hemostasis, Department of Medicine I Thrombosis Research, Dresden, Saxony, Germany
Dresden, Sachsen, Germany
SS

Sebastian Schellong

Director of Municipal Hospital
Medical Department 2, Municipal Hospital, Dresden, Germany
Dresden, Sachsen, Germany
PM

Patrick Meybohm

MD, Head of
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
Würzburg, Bayern, Germany
AG

Andreas Greinacher

MD, Head of
Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Germany
Greifswald, Mecklenburg-Vorpommern, Germany
EH

Eva Herrmann

PhD, Head of
Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Frankfurt, Germany
Frankfurt, Hessen, Germany

Background: Besides Vitamin K antagonists (VKA), direct oral anticoagulants (DOAC) are frequently used for oral anticoagulation. However, clinical management of anticoagulated patients needing emergency surgeries is challenging and evidence is scarce.

Aims: The RADOA registry is a prospective, investigator-initiated, observational, non-interventional registry that aimed to analyze clinical practice of different treatment strategies in VKA- or DOAC-treated patients who needed emergency surgeries within 24 hours after admission to hospital.

Methods: Patients were recruited at 10 German centres from April 2014 to March 2018. Effectiveness was analysed by clinical outcome measures including peri- and postoperative major bleeding, application of prothrombin complex concentrates (PCC), fresh frozen plasma (FFP) or other hemostatic agents. Primary observation endpoint was 30 day-in hospital mortality.

Results: 78 patients were included, 44 treated with a DOAC and 34 treated with VKA. Median age was 76 years. Indications for emergency surgeries were mainly bone fractures or abdominal emergencies. Within 24 hours after admission, 4.6% of the DOAC patients (2/44) and 11.8% of the VKA patients (4/34) had a major bleeding at the surgical site (p>0.20). Treatment management was highly diverse. While 79.4% of the VKA patients (27/34) received PCC, only 43.2% of the DOAC-patients (19/44) were treated with PCC (p=0.002). FFP was also significantly more frequently applied in VKA-patients compared to DOAC-patients (35.3%: 12/34 vs. 6.8%: 3/44; p=0.003). 29.5% of the DOAC patients (13/44) received no hemostatic treatment compared to only 2.9% (1/34) of the VKA patients (p=0.002). In hospital mortality was 12.8% (10/78) with no significant difference between the two treatment groups (DOAC-patients: 11.4%, 5/44; VKA-patients: 14.7% (5/34), p>0.20).

Conclusion(s): 30 day-in hospital mortality was comparable in both patient groups, although significantly more DOAC treated patients did not receive any hemostatic treatment while the majority of VKA patients were treated with multiple hemostatic agents.