Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2020 Jul;7(2):e001278.
doi: 10.1136/openhrt-2020-001278.

Operative survival in patients with acute aortic disease in the era of newer oral anticoagulants

Johannes Lagethon Bjørnstad  1   2 , Adil Mahboob Khan  3 , Henriette Røed-Undlien  2 , Bjørn Bendz  2   4 , Ståle Nygård  5 , Tom Nilsen Hoel  3 , Per Snorre Lingaas  3
Affiliations
Comparative Study

Operative survival in patients with acute aortic disease in the era of newer oral anticoagulants

Johannes Lagethon Bjørnstad et al. Open Heart. 2020 Jul.

Abstract

Aims: The aim of this study was the analysis of the risk associated with direct oral anticoagulants (DOACs) in patients undergoing non-elective operations on the proximal aorta due to aortic disease.

Methods and results: Data from the department's register of cardiac surgery was analysed retrospectively with emphasis on operative mortality. 135 non-elective operations for proximal aortic disease (October 2016 to 2018) were identified, of which 19 died during the first 90 days. DOAC use was the top-ranked risk factor in the univariate analysis with a HR of 9.6 (3.1 to 29), p=0.00007. Using a Cox proportional hazards model including the most relevant risk factors, the risk associated with DOAC use remained significant with a HR of 6.1 (1.4 to 26.3), p=0.015. We did not find increased risk associated with warfarin use.

Conclusion: In patients undergoing non-elective operations on the proximal aorta due to aortic disease, the use of DOAC is associated with increased operative mortality.

Keywords: cardiac surgery; dissection; pharmacology.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Unadjusted operative survival for patients using DOAC versus patients not using DOAC (A). Unadjusted operative survival for patients using warfarin versus patients not using warfarin (B). DOAC, direct oral anticoagulants.
Figure 2
Figure 2
Forest plot from the final multivariate model. DOAC, direct oralanticoagulants. *p<0.05, ***p<0.001
Figure 3
Figure 3
Adjusted operative survival for patients using DOAC versus patients not using DOAC (A). Adjusted operative survival for patients using warfarin versus patients not using warfarin (B). DOAC, direct oralanticoagulants.
See this image and copyright information in PMC

References

    1. Pagano D, Milojevic M, Meesters MI, et al. . 2017 EACTS/EACTA guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg 2018;53:79–111. 10.1093/ejcts/ezx325 - DOI - PubMed
    1. Granger CB, Alexander JH, McMurray JJV, et al. . Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981–92. 10.1056/NEJMoa1107039 - DOI - PubMed
    1. Connolly SJ, Ezekowitz MD, Yusuf S, et al. . Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139–51. 10.1056/NEJMoa0905561 - DOI - PubMed
    1. Giugliano RP, Ruff CT, Braunwald E, et al. . Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013;369:2093–104. 10.1056/NEJMoa1310907 - DOI - PubMed
    1. Patel MR, Mahaffey KW, Garg J, et al. . Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883–91. 10.1056/NEJMoa1009638 - DOI - PubMed

Publication types

MeSH terms