Safety of Apixaban and Rivaroxaban Compared to Warfarin After Cardiac Surgery

Overview

Journal J Card Surg

Specialties Cardiology & Vascular Diseases
General Surgery

Date 2022 Dec 8

PMID 36478440

Authors

Kushal D Naik

Bryan A Whitson

Eric M McLaughlin

Nancy B Matre

Alan J Rozycki

Affiliations

Soon will be listed here.

Abstract

Background: Direct oral anticoagulants (DOACs) are frequently prescribed for the management of atrial fibrillation and venous thrombosis. There is a lack of published data on the utilization of DOACs in individuals who have undergone recent cardiac surgery. The purpose of this study was to evaluate the safety and efficacy of apixaban and rivaroxaban compared to warfarin in patients postcardiac surgery.

Methods: In this retrospective cohort study, patients were separated into a DOAC cohort or a warfarin cohort based on the agent they received after cardiac surgery. Patients could be included if they were ≥18 years of age and received or were discharged on either rivaroxaban, apixaban, or warfarin within 7 days after cardiac surgery. The primary outcome for the study was the rate of International Society on Thrombosis and Hemostasis (ISTH) major bleeding during hospitalization and for 30 days following discharge or until first follow-up appointment.

Results: There were a total of 194 patients included in the analysis, 97 in the DOAC cohort and 97 in the warfarin cohort. Four patients (4.1%) in the DOAC group experienced ISTH major bleeding, while 2 patients (2.1%) in the warfarin cohort experienced ISTH major bleeding (p = 0.68). No patients in the DOAC cohort experienced a thrombotic event, whereas 2 patients (2.1%) in the warfarin cohort experienced a thrombotic complication (p = 0.5).

Conclusion: Apixaban and rivaroxaban demonstrated similar safety when compared to a matched cohort of warfarin patients. Larger prospective randomized studies are needed to confirm these findings.

Citing Articles

Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trial.

Pereira M, Lima E, Pitta F, Gowdak L, Mioto B, Carvalho L JTCVS Open. 2023; 15:199-210.

PMID: 37808050 PMC: 10556832. DOI: 10.1016/j.xjon.2023.05.006.

Safety of apixaban and rivaroxaban compared to warfarin after cardiac surgery.

Naik K, Whitson B, McLaughlin E, Matre N, Rozycki A J Card Surg. 2022; 37(12):4740-4747.

PMID: 36478440 PMC: 10107629. DOI: 10.1111/jocs.17203.

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