Is a standardized perioperative management approach safe for patients with atrial fibrillation (AF) who use a direct oral anticoagulant and require elective surgery or procedure? This question was at the heart of the Perioperative Anticoagulation Use for Surgery Evaluation (PAUSE) study.
This cohort study of 3007 patients with AF using apixaban, dabigatran, or rivaroxaban, the direct oral anticoagulant treatment was stopped and resumed before and/or after elective surgery or procedure using standardized protocols without heparin bridging. The 30-day postoperative rates of major bleeding were less than 2%, and the rates of stroke were less than 1%.
We are fortunate to have authors James Douketis, MD and Nathan Clark, PharmD join our AC Forum panel of experts for a discussion of the results.