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Thrombosis Journal
Published in: Thrombosis Journal 1/2023

Open Access 01-12-2023 | Edoxaban | Research

Management of edoxaban therapy and clinical outcomes in patients undergoing major or nonmajor surgery: a subanalysis of the EMIT-AF/VTE study

Authors: Christian von Heymann, Martin Unverdorben, Paolo Colonna, Amparo Santamaria, Manish Saxena, Thomas Vanassche, Sabine Köhler, Amanda P. Borrow, James Jin, Cathy Chen

Published in: Thrombosis Journal | Issue 1/2023

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Abstract

Background

Optimising periprocedural management of direct oral anticoagulation in patients with atrial fibrillation on chronic treatment undergoing major surgeries is an important aspect of balancing the risk of surgery-related bleeding with the risk of thromboembolic events, which may vary by surgery type.

Methods

This subanalysis of the prospective EMIT-AF/VTE programme assessed periprocedural-edoxaban management, according to physicians’ decisions, and bleeding and thromboembolic event rates in patients who underwent major vs. nonmajor surgeries. Edoxaban interruption and clinical outcomes were compared between major vs. nonmajor surgeries and between renal function subgroups (creatinine clearance [CrCL] ≤ 50 mL/min vs. > 50 mL/min).

Results

We included 276 major and 512 nonmajor surgeries. The median pre- and postprocedural duration of edoxaban interruption in major vs. nonmajor surgeries was 4 vs. 1 days, whereas median duration of interruption for those with preprocedural-only and postprocedural-only interruption was 2 vs. 1 days and 2 vs. 0 days, respectively (P < 0.0001). Rates of all bleeding and clinically relevant nonmajor bleeding were numerically higher in major vs. nonmajor surgeries. Event rates (number of events per 100 surgeries) were low overall (< 6 events per 100 surgeries), independent of renal function subgroups.

Conclusion

In this subanalysis of the EMIT-AF/VTE programme, periprocedural-edoxaban interruption was significantly longer in patients undergoing major vs. nonmajor surgery. This clinician-driven approach was associated with low rates of bleeding and thromboembolic events following both major and nonmajor surgeries.

Trial registration

NCT02950168, registered October 31, 2016; NCT02951039, registered November 1, 2016.
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Metadata
Title
Management of edoxaban therapy and clinical outcomes in patients undergoing major or nonmajor surgery: a subanalysis of the EMIT-AF/VTE study
Authors
Christian von Heymann
Martin Unverdorben
Paolo Colonna
Amparo Santamaria
Manish Saxena
Thomas Vanassche
Sabine Köhler
Amanda P. Borrow
James Jin
Cathy Chen
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Thrombosis Journal / Issue 1/2023
Electronic ISSN: 1477-9560
DOI
https://doi.org/10.1186/s12959-023-00568-2

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