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

Authors:
Hua He
Hua He
China Pharmaceutical University
Nanjing Shi | China
Bingbing Ke
Bingbing Ke
Beijing Anzhen Hospital
Dr. Yan Li, PhD
Dr. Yan Li, PhD
Experimental Therapeutics Centre
Research Fellow
Singapore | Singapore
Xiaodong Li
Xiaodong Li
Zhejiang University
China
Yujie Zeng
Yujie Zeng
Sun Yat-sen University
China

J Thromb Thrombolysis 2018 Apr;45(3):386-396

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

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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http://dx.doi.org/10.1007/s11239-018-1612-7DOI Listing
April 2018
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