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Novel oral anticoagulants in the preoperative period: a meta-analysis

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Abstract

The purpose of this study is to evaluate the efficacy and safety of novel oral anticoagulant (NOAC) versus warfarin therapy in patients undergoing different operations. We performed a systematic review of MEDLINE, EMBASE, Cochrane Controlled Trials Register, and reports presented at scientific meetings. The efficacy and safety of NOACs during the perioperative period was compared to that using warfarin. Of the 2652 studies initially reviewed, we identified 9 that included 15,880 patients for the meta-analysis. Compared to warfarin, dabigatran increased the risk of major bleeding (RR 1.37, 95% CI 1.06–1.78, P = 0.02). Apixaban (RR 0.63, 95% CI 0.40–0.99, P = 0.04) reduced thrombotic events. NOAC therapy decreased thrombotic events in patients undergoing non-cardiac surgery (RR 0.68, 95% CI 0.50–0.92, P = 0.02). Compared to warfarin, the administration of NOACs in the perioperative period has the same risk of thromboembolism and major bleeding. But patients undergoing non-cardiac surgery may benefit more from perioperative NOAC therapy. Apixaban may reduce thrombotic events and dabigatran increases the risk of major bleeding during the perioperative period.

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Funding

The Cultivating Project Grants of Beijing for Highly Talented Men of Medicine (2014-3-042) and grants from Beijing Key Laboratory of Cardiovascular Diseases Related to Metabolic Disturbance supported this study.

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Author notes

  1. Hua He and Bingbing Ke have contributed equally to this work.

Authors and Affiliations

  1. Department of Emergency Cardiology, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road Second, Chaoyang District, Beijing, 100029, People’s Republic of China

    Hua He, Bingbing Ke, Yan Li, Xiaodong Li & Yujie Zeng

  2. Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, People’s Republic of China

    Fuheng Han

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  1. Hua He
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  2. Bingbing Ke
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Correspondence to Hua He.

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11239_2018_1612_MOESM1_ESM.tif

Figure S1. Distribution of surgical/invasive procedures, showing the frequency of different types of surgical procedures that were used in the eligible studies. CABG, coronary artery-bypass graft; GI, gastrointestinal; PCI, percutaneous coronary intervention; ICD, implantable cardioverter defibrillator and CRT, Cardiac resynchronization. Supplementary material 1 (TIF 6790 KB)

11239_2018_1612_MOESM2_ESM.tiff

Figure S2. Begg’s and Egger’s tests for publication bias in all outcomes. There was no significant publication bias in this article. The red vertical line represents P = 0.05. P value was always > 0.05 for both Begg’s and Egger’s tests for publication bias, which indicated that there was no significant publication bias in all-cause mortality, major bleeding, and thrombosis in the studies included in the meta analysis. Supplementary material 2 (TIFF 171 KB)

11239_2018_1612_MOESM3_ESM.tif

Figure S3. Sensitivity analyses to assess the contribution of each study and the effect of choice of summary statistics. The outcomes of thrombosis, major bleeding, and all-cause mortality were included. Supplementary material 3 (TIF 504 KB)

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He, H., Ke, B., Li, Y. et al. Novel oral anticoagulants in the preoperative period: a meta-analysis. J Thromb Thrombolysis 45, 386–396 (2018). https://doi.org/10.1007/s11239-018-1612-7

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