PDF(Pubmed)
Abstract：
(1) Background: The clinical management of anticoagulated patients treated with direct oral anticoagulants (DOAC) or Vitamin K antagonists (VKA) needing emergency surgery is challenging. (2) Methods: The prospective German RADOA registry investigated treatment strategies in DOAC- or VKA-treated patients needing emergency surgery within 24 h after admission. Effectiveness was analysed by clinical endpoints including major bleeding. Primary observation endpoint was in hospital mortality until 30 days after admission. (3) Results: A total of 78 patients were included (DOAC: 44; VKA: 34). Median age was 76 years. Overall, 43% of the DOAC patients and 79% of the VKA patients were treated with prothrombin complex concentrates (PCC) (p = 0.002). Out of the DOAC patients, 30% received no hemostatic treatment compared to 3% (1/34) of the VKA patients (p = 0.002), and 7% of the DOAC patients and 21% of the VKA patients developed major or clinically relevant non-major bleeding at the surgical site (p = 0.093). In-hospital mortality was 13% with no significant difference between the two treatment groups (DOAC: 11%, VKA: 15%; p > 0.20). (4) Conclusions: The 30-day in-hospital mortality rate was comparable between both patient groups. VKA patients required significantly more hemostatic agents than DOAC patients in the peri- and postoperative surgery period.
摘要：
（1）背景：需要紧急手术的直接口服抗凝剂（DOAC）或维生素K拮抗剂（VKA）治疗的抗凝患者的临床管理具有挑战性。（2）方法：前瞻性德国RADOA注册研究了入院后24小时内需要进行急诊手术的DOAC或VKA治疗的患者的治疗策略。通过包括大出血在内的临床终点分析有效性。主要观察终点是入院后30天之前的住院死亡率。(3)结果:共纳入78例患者(DOAC:44;VKA:34)。中位年龄为76岁。总的来说,43%的DOAC患者和79%的VKA患者用凝血酶原复合物浓缩物(PCC)治疗(p=0.002)。在DOAC患者中，30％的VKA患者没有接受止血治疗，而3％（1/34）的VKA患者（p=0.002），7％的DOAC患者和21％的VKA患者在手术部位发生了严重或临床相关的非严重出血（p=0.093）。住院死亡率为13％，两个治疗组之间没有显着差异（DOAC：11％，VKA：15%；p>0.20）。（4）结论：两组患者的30天住院死亡率具有可比性。在围手术期和术后手术期，VKA患者比DOAC患者需要更多的止血剂。
