So much research has been done on management of warfarin before and after procedures. But direct oral anticoagulants are more commonly prescribed. How is bleeding risk similar or different between DOAC- and warfarin-treated patients? 🧵
https://twitter.com/umichCVC/status/1564698471080280066
DOACs have a shorter half-life than warfarin. So they don’t require “bridging” with heparin. Warfarin has a long half-life, so sometimes we give bridging heparin… but that’s becoming less and less common.
When warfarin was held and no bridging heparin was given, patients had lower perioperative bleeding rates than when DOACs were used.
When warfarin was held & a short course of bridging #cvCoag was used, bleeding was similar to patients on DOACs. 
Of note, there was no standard protocol for DOAC management. These data include patients undergoing procedure both before & after the PAUSE trial was published. ncbi.nlm.nih.gov/pubmed/31380891
This study confirmed what we expected – longer periods of time without anticoag pre/post procedure lead to fewer bleeding events. Bleeding risk is an important factor to consider in peri-procedural #cvCoag management.
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