DOACs can continue during cardiac-device surgery

Working off of previous evidence, researchers wondered if continued therapy with direct oral anticoagulants (DOACs) would lower the risk of hematoma during cardiac-device surgery.

Working off of previous evidence, researchers wondered if continued therapy with direct oral anticoagulants (DOACs) would lower the risk of hematoma during cardiac-device surgery. However, based on the results of their BRUISE CONTROL-2 study, the rate of clinically relevant hematoma in this setting was the same—2.1%—no matter if DOAC therapy was maintained or suspended. Secondary outcomes, including stroke/transient ischemic attack, were also comparable for the 662 trial participants randomized to DOAC continuation or interruption during the device procedure. The results suggest that either approach is feasible depending on the clinical circumstances, according to co-lead investigator David H. Birnie, MD, of the Ottawa Heart Institute, especially given the concern with stopping anticoagulants in certain populations. Surgeons might want to continue DOAC therapy, he theorized, when performing device surgery on patients who have total heart block, unstable temporary pacing, moderate-to-high risk of thromboembolism, or a recent history of atrial ablation, for example. Birnie presented the findings at the American Heart Association 2017 Scientific Sessions.