Patients with atrial fibrillation who undergo surgical procedures need special attention because their anticoagulant medications, if not adjusted, increase their risk for bleeding. Those on direct-acting oral anticoagulants — or “DOACs” — face special problems because assays for the amount of drug on-board before surgery are not routinely available.

Dr. James Douketis and international colleagues have a simpler approach in their PAUSE study. On the basis of the known pharmacokinetics of DOACs, they dispense with coagulation testing and heparin bridging. Their approach involves assessing the likelihood of the procedure to cause bleeding. For low-risk procedures, DOACs are suspended a day before and resumed a day after; for riskier procedures, like resections, it’s two days before and two after.

The drugs under study were apixaban, dabigatran, and rivaroxaban.

We discuss the PAUSE results with Dr. Douketis.

LINKS:

JAMA Internal Medicine paper on PAUSE study

Physician’s First Watch summary (with links to other resources)