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A retrospective analysis of the periprocedural management of oral anticoagulants in patients undergoing interventional radiology procedures

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Abstract

Limited evidence is available to guide periprocedural management of oral anticoagulants in the setting of interventional radiology (IR) procedures. For direct oral anticoagulants, therapy interruption (TI) is based on medication half-life and procedural bleeding risk. Periprocedural management of warfarin includes INR monitoring, and possible bridging with parenteral anticoagulants. It is unknown if these recommendations apply to IR procedures. To evaluate bleeding complications and thromboembolic events following periprocedural management of the factor Xa (FXa) inhibitors or warfarin in patients undergoing IR procedures. We performed a retrospective, observational study at NYU Langone Health (NYULH) of all adult patients who underwent an IR procedure from January 2015 to July 2017 and were receiving apixaban, rivaroxaban, or warfarin. Patients who were pregnant or who had a mechanical heart valve were excluded. At NYULH, TI is not required for FXa inhibitors, and an INR < 3 is recommended for patients on warfarin undergoing low risk procedures. For moderate/high risk procedures, TI for 48 h or 72 h with reduced renal function, is recommended for FXa inhibitors, and an INR < 1.5 is recommended for patients on warfarin. We evaluated 350 IR procedures, with a total of 174 low bleeding risk and 176 moderate/high bleeding risk. The 30-day major bleeding rate was 0.9%, clinically relevant non-major bleeding rate was 3%, minor bleeding rate was 1% and thromboembolic event rate was 1%. The periprocedural oral anticoagulation management strategy at NYULH appears safe given the low 30-day incidence of bleeding and thromboembolic events.

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Authors and Affiliations

  1. Department of Pharmacy, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    Kassandra Marsh, Tania Ahuja, Veronica Raco & John Papadopoulos

  2. Division of Hematology, Department of Medicine, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    David Green

  3. Division of Vascular Interventional Radiology, Department of Radiology, NYU Langone Health, 550 First Avenue, New York, NY, 10016, USA

    Akhilesh K. Sista

Authors
  1. Kassandra Marsh
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  2. Tania Ahuja
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  3. Veronica Raco
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  4. David Green
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  5. Akhilesh K. Sista
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  6. John Papadopoulos
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Contributions

All authors have fulfilled the conditions required for authorship. KM performed research, analyzed and interpreted data, and wrote the first draft of the manuscript. TA designed research, interpreted data and provided vital review and oversight of the research and the manuscript. VR interpreted data and provided reviews of the manuscript. DG, AS, and JP provided vital reviews of the manuscript. The final version of this manuscript has been read and approved for submission by all authors.

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Correspondence to Tania Ahuja.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Marsh, K., Ahuja, T., Raco, V. et al. A retrospective analysis of the periprocedural management of oral anticoagulants in patients undergoing interventional radiology procedures. J Thromb Thrombolysis 46, 451–460 (2018). https://doi.org/10.1007/s11239-018-1740-0

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