Elective surgeries and procedures are relatively common amongst people with atrial fibrillation (AF), many of whom are now treated with Direct Oral Anticoagulants (DOACs) but optimal perioperative management strategies remain unclear. The ‘Perioperative Anticoagulation Use for Surgery Evaluation’ (PAUSE) cohort study was conducted in 23 clinical centres in Canada, the United States, and Europe and involved 3,007 patients with AF (mean age [SD]: 72.5 [9.39] years) who were long-term users of apixaban (41.8%), dabigatran (22.2%) or rivaroxaban (36.0%), who had elective surgery/procedure arrangements and could follow instructions for a standardised DOAC therapy interruption protocol to be used without heparin bridging. For those with a high-bleeding-risk procedure (33.5%), DOAC therapy was interrupted 2 days before and resumed 2-3 days after, and for those with a low-bleeding-risk procedure, DOAC therapy was interrupted 1 day before and resumed 1 day after. Patient follow-ups were completed after 30 days – the postoperative rates of major bleeding and arterial thromboembolism were <2% and <1% respectively. The original report, which can be viewed here, concludes that the standardised perioperative management strategy for patients in this study was linked to low rates of bleeding and stroke. Superficially, rates for the two major study endpoints appeared to vary between drugs but the study was not designed to effectively assess this issue.

Contributed by Australian Medication Safety Services Associate – Isabella Singh