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Risk of stroke and other thromboembolic complications after interruption of DOAC therapy compared with warfarin therapy in patients with atrial fibrillation: a retrospective cohort analysis
  1. Moran Hellerman Itzhaki1,2,
  2. Noam Greenberg2,3,
  3. Ili Margalit2,4,
  4. Tzippy Shochat2,5,
  5. Ilan Krause2,6,
  6. Elad Goldberg1,2
  1. 1 Department of General Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
  2. 2 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  3. 3 Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
  4. 4 Infectious Disease Unit, Rabin Medical Center, Beilnson Hospital, Petah Tikva, Israel
  5. 5 Statistical Consulting Unit, Rabin Medical Center, Beilnson Hospital, Petah Tikva, Israel
  6. 6 Department of Internal Medicine F- Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
  1. Correspondence to Dr Moran Hellerman Itzhaki, Rabin Medical Center, Petah Tikva 49100, Israel; moranhe{at}clalit.org.il

Abstract

Direct oral anticoagulants (DOACs) have become the treatment of choice in thromboembolism prophylaxis for non-valvular atrial fibrillation, surpassing warfarin. While interruption of DOAC therapy for various reasons is a common eventuality, the body of data from real-world clinical practice on the implications of such interruptions in different clinical settings is still limited. We assessed complication rates from DOAC (apixaban, rivaroxaban, dabigatran) interruption compared with warfarin in hospitalized patients. We performed a retrospective cohort analysis of electronic records of patients hospitalized in Rabin Medical Center between 2010 and 2017. Incidents of anticoagulation interruptions for various reasons (including unintended interruptions) were collected. DOAC-treated patients were excluded if they reported non-compliance, and warfarin-treated patients were excluded if their international normalized ratio measurement on admission was subtherapeutic. Outcomes included ischemic stroke, systemic thromboembolism, myocardial infarction, and all-cause mortality within 90 days of anticoagulation interruption. The median CHA2DS2-VASc score was 5.0 (IQR 4.0–6.0) in both treatment groups. The associated risk of stroke, thromboembolic complications, myocardial infarction, and all-cause mortality after interruption of anticoagulation was not significantly different between the 2 treatment groups. Selective comparison of patients who were well balanced on warfarin before treatment interruption to DOAC-treated patients did not significantly influence the outcomes. This study did not find a significant difference in the complication rate after interruption of DOAC therapy compared with interruption of warfarin therapy in hospitalized patients with a high risk of thromboembolism.

  • anticoagulants
  • atrial fibrillation
  • stroke
  • postoperative period

Data availability statement

Deidentified participant data are available upon reasonable request to the authors.

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Data availability statement

Deidentified participant data are available upon reasonable request to the authors.

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Footnotes

  • MHI and NG contributed equally.

  • Contributors MHI, NG: substantial contributions to the conception and design of the work, drafted the work and contributed substantially to the acquisition, analysis, and interpretation of data for the work. IM: substantial contributions to the conception and design of the work. TS: substantial contributions to the analysis and interpretation of data for the work. IK: substantial contributions to the conception and design of the work and final approval of the version to be published. EG: substantial contributions to the conception and design of the work, contributed substantially to the analysis and interpretation of data and final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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