DOACs may be beneficial in post-op atrial fib after CABG

 

SAN DIEGO – The use of direct oral anticoagulants were not significantly different from warfarin for safety and efficacy in cases of postoperative atrial fibrillation following coronary artery bypass grafting, according to results from a single-center study.

In fact, patients who took rivaroxaban and apixaban had significantly shorter postoperative lengths of stay, which suggests a potential for reduced hospital stay-related costs. “There are several different niche populations for which the DOACs have not been studied,” one of the study authors, Ammie J. Patel, PharmD, said in an interview at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “This provides the opportunity for institutions and hospitals to study the use of these drugs in non-traditional ways.”

Dr. Patel, of Temple University, Philadelphia, said that postoperative atrial fibrillation occurs in about 30% of patients following CABG and that new-onset postoperative atrial fibrillation after CABG has been linked to a 21% increase in relative mortality.

Noting that patients with planned major surgery were excluded from RE-LY, ROCKET AF, ARISTOTLE, and other pivotal clinical trials of DOACs, she and her research mentor, Rachael Durie, PharmD, retrospectively evaluated the safety and efficacy of DOACs in 285 cases of new-onset postoperative atrial fibrillation following CABG performed at Jersey Shore University Medical Center, Neptune, N.J., between July 1, 2014, and June 30, 2016. They hypothesized that using DOACs in this patient population might offer advantages over warfarin, including rapid onset and earlier hospital discharge, fewer drug interactions, and no coagulation monitoring.

 

Of the 146 patients on anticoagulants, 79 were discharged on warfarin, 43 on apixaban, 20 on rivaroxaban, and 4 on dabigatran. The other 139 patients were not anticoagulated for various reasons, one of which included normal sinus rhythm at discharge.

The researchers found that the DOACs were not significantly different from warfarin for efficacy endpoints in stroke (P = 0.23) or systemic embolism (P = 0.68). Safety endpoints also were similar among all groups for major bleeding (P = 0.57) or minor bleeding (P = 0.63). Median post-CABG length of stay was significantly longer in the warfarin group (8 days, P = 0.005), compared with dabigatran (7.5 days), rivaroxaban (6.5 days), and apixaban (6 days). In addition, the median total hospital length of stay was significantly longer with warfarin (11 days, P = 0.004), compared with rivaroxaban (8.5 days) and apixaban (9 days), but not compared with dabigatran (12 days).

Dr. Patel acknowledged that the study’s retrospective design and small sample size are limitations and said that larger prospective trials are warranted to confirm these results. She reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SOURCE: Patel AJ et al. THSNA 2018. Poster 64.

 

SAN DIEGO – The use of direct oral anticoagulants were not significantly different from warfarin for safety and efficacy in cases of postoperative atrial fibrillation following coronary artery bypass grafting, according to results from a single-center study.

In fact, patients who took rivaroxaban and apixaban had significantly shorter postoperative lengths of stay, which suggests a potential for reduced hospital stay-related costs. “There are several different niche populations for which the DOACs have not been studied,” one of the study authors, Ammie J. Patel, PharmD, said in an interview at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “This provides the opportunity for institutions and hospitals to study the use of these drugs in non-traditional ways.”

Dr. Patel, of Temple University, Philadelphia, said that postoperative atrial fibrillation occurs in about 30% of patients following CABG and that new-onset postoperative atrial fibrillation after CABG has been linked to a 21% increase in relative mortality.

Noting that patients with planned major surgery were excluded from RE-LY, ROCKET AF, ARISTOTLE, and other pivotal clinical trials of DOACs, she and her research mentor, Rachael Durie, PharmD, retrospectively evaluated the safety and efficacy of DOACs in 285 cases of new-onset postoperative atrial fibrillation following CABG performed at Jersey Shore University Medical Center, Neptune, N.J., between July 1, 2014, and June 30, 2016. They hypothesized that using DOACs in this patient population might offer advantages over warfarin, including rapid onset and earlier hospital discharge, fewer drug interactions, and no coagulation monitoring.

 

Of the 146 patients on anticoagulants, 79 were discharged on warfarin, 43 on apixaban, 20 on rivaroxaban, and 4 on dabigatran. The other 139 patients were not anticoagulated for various reasons, one of which included normal sinus rhythm at discharge.

The researchers found that the DOACs were not significantly different from warfarin for efficacy endpoints in stroke (P = 0.23) or systemic embolism (P = 0.68). Safety endpoints also were similar among all groups for major bleeding (P = 0.57) or minor bleeding (P = 0.63). Median post-CABG length of stay was significantly longer in the warfarin group (8 days, P = 0.005), compared with dabigatran (7.5 days), rivaroxaban (6.5 days), and apixaban (6 days). In addition, the median total hospital length of stay was significantly longer with warfarin (11 days, P = 0.004), compared with rivaroxaban (8.5 days) and apixaban (9 days), but not compared with dabigatran (12 days).

Dr. Patel acknowledged that the study’s retrospective design and small sample size are limitations and said that larger prospective trials are warranted to confirm these results. She reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SOURCE: Patel AJ et al. THSNA 2018. Poster 64.

 

SAN DIEGO – The use of direct oral anticoagulants were not significantly different from warfarin for safety and efficacy in cases of postoperative atrial fibrillation following coronary artery bypass grafting, according to results from a single-center study.

In fact, patients who took rivaroxaban and apixaban had significantly shorter postoperative lengths of stay, which suggests a potential for reduced hospital stay-related costs. “There are several different niche populations for which the DOACs have not been studied,” one of the study authors, Ammie J. Patel, PharmD, said in an interview at the biennial summit of the Thrombosis & Hemostasis Societies of North America. “This provides the opportunity for institutions and hospitals to study the use of these drugs in non-traditional ways.”

Dr. Patel, of Temple University, Philadelphia, said that postoperative atrial fibrillation occurs in about 30% of patients following CABG and that new-onset postoperative atrial fibrillation after CABG has been linked to a 21% increase in relative mortality.

Noting that patients with planned major surgery were excluded from RE-LY, ROCKET AF, ARISTOTLE, and other pivotal clinical trials of DOACs, she and her research mentor, Rachael Durie, PharmD, retrospectively evaluated the safety and efficacy of DOACs in 285 cases of new-onset postoperative atrial fibrillation following CABG performed at Jersey Shore University Medical Center, Neptune, N.J., between July 1, 2014, and June 30, 2016. They hypothesized that using DOACs in this patient population might offer advantages over warfarin, including rapid onset and earlier hospital discharge, fewer drug interactions, and no coagulation monitoring.

 

Of the 146 patients on anticoagulants, 79 were discharged on warfarin, 43 on apixaban, 20 on rivaroxaban, and 4 on dabigatran. The other 139 patients were not anticoagulated for various reasons, one of which included normal sinus rhythm at discharge.

The researchers found that the DOACs were not significantly different from warfarin for efficacy endpoints in stroke (P = 0.23) or systemic embolism (P = 0.68). Safety endpoints also were similar among all groups for major bleeding (P = 0.57) or minor bleeding (P = 0.63). Median post-CABG length of stay was significantly longer in the warfarin group (8 days, P = 0.005), compared with dabigatran (7.5 days), rivaroxaban (6.5 days), and apixaban (6 days). In addition, the median total hospital length of stay was significantly longer with warfarin (11 days, P = 0.004), compared with rivaroxaban (8.5 days) and apixaban (9 days), but not compared with dabigatran (12 days).

Dr. Patel acknowledged that the study’s retrospective design and small sample size are limitations and said that larger prospective trials are warranted to confirm these results. She reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SOURCE: Patel AJ et al. THSNA 2018. Poster 64.