SHM Converge Scientific Abstract ePoster Gallery-Peri-Operative Doac Protocol Adherence: Don't Set It and Forget It

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This retrospective single-center study examined peri-operative direct oral anticoagulant (DOAC) management at a large urban tertiary care hospital from September 2018 to October 2023. The researchers reviewed 1,073 procedures in patients taking treatment-dose DOACs and compared actual practice with the hospital’s protocol for how long DOACs should be held before and after surgery. They also assessed surgery type, spinal anesthesia use, and renal function. Non-adherence was defined as a one-day deviation from protocol. A sample of 50 charts with non-adherence was manually reviewed to confirm data accuracy and identify reasons for deviation.<br /><br />Overall adherence was low. In the pre-operative period, adherence was 37.1% (194 of 523 cases). In the post-operative period, adherence was even lower at 10.7% (38 of 354 cases). Documentation explaining why the protocol was not followed was uncommon pre-operatively (25.0%) but more frequent post-operatively (59.5%). Common documented reasons for holding DOACs longer than recommended included having multiple procedures close together, concern for bleeding, spinal anesthesia planning, serosanguinous or bloody drainage, use of prophylactic rather than treatment-dose anticoagulation, and awaiting surgical team assessment.<br /><br />The study also highlighted limitations of administrative database review, including missing renal function data for many patients and some misclassification of prophylactic-dose anticoagulation as treatment-dose DOAC use.<br /><br />The authors concluded that adherence to evidence-based peri-operative DOAC protocols was poor in both pre- and post-operative settings, and that documentation of reasons for deviation was especially lacking before surgery. They suggested that real-time electronic guidance and other decision-support tools may help improve protocol adherence and peri-operative anticoagulation safety.

Asset Subtitle

Andrew S. Dunn

Meta Tag

Author List Andrew S. Dunn, Mark Shneyderman, Pooja Anand Gownivaripally, Rebecca A. Tejiram, Sawant S. Ashwin MD

Category Research

Concept Peri-operative DOAC Management Protocol

Concept Direct Oral Anticoagulant

Concept Adherence

Concept Timing of Hold

Concept Resumption Timing

Distinguished Non-Finalist

Presenter Organization Mount Sinai Health System

Presenting Author Andrew S. Dunn

Track Quality Improvement

Keywords

peri-operative DOAC management

direct oral anticoagulants

protocol adherence

retrospective single-center study

surgical anticoagulation

pre-operative holding

post-operative resumption

spinal anesthesia

renal function

decision-support tools

Peri-operative DOAC Management Protocol

Direct Oral Anticoagulant

Adherence

Timing of Hold

Resumption Timing