Perioperative interruption of direct oral anticoagulants in patients with atrial fibrillation: A systematic review and meta‐analysis
Bibliographic record
Abstract
Unlabelled Box •Little evidence exists to guide procedural interruption of direct oral anticoagulants (DOACs). •Conducted a meta‐analysis of the interruption of DOACs in patients with atrial fibrillation (AF). •The 30‐day risk for thromboembolic and major bleeding events were 0.4% and 1.8%, respectively. •Perioperative interruption of DOACs in patients with AF appears to be safe and effective. Background Patients with atrial fibrillation (AF) frequently undergo invasive procedures that require temporary interruption of anticoagulation. There is little evidence to guide the perioperative interruption of direct oral anticoagulants (DOACs). Methods A systematic literature search including studies that evaluated the perioperative interruption of DOACs for non‐emergent invasive procedures in patients with AF was performed. The primary outcomes of interest were the 30‐day risk of thromboembolic events and major bleeding. Secondary outcomes of interest included the 30‐day risk of minor bleeding and overall mortality. The systematic review protocol and search strategy were registered online (PROSPERO January 27th 2017:CRD42017056124). Results A total of 8 publications encompassing 14 446 patients and 17 107 periprocedural interruptions were included in our study. Our analysis revealed a pooled postoperative 30‐day thromboembolic complication risk of 0.41% (95% CI 0.29‐ 0.54), and a pooled 30‐day postoperative major bleeding risk of 1.81% (95% CI 0.84‐3.13). Pooled 30‐day postoperative risks of minor bleeding and overall mortality were 3.08% (95% CI 1.02‐6.20) and 0.67% (95% CI 0.29‐1.23), respectively. Meta‐analysis of the included comparative studies did not reveal any significant differences in these postoperative outcomes following the perioperative interruption of DOACs or vitamin K antagonists. Conclusions The perioperative interruption of DOACs in patients with AF was associated with 0.4% thromboembolic and 1.8% major bleeding events at 30 days post surgery. These findings seem reassuring, but require validation in large prospective management studies where pre‐operative DOAC levels are measured and compared with clinical outcomes in this patient population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.030 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".