Abstract
It is estimated that 10–15% of oral anticoagulant (OAC) patients, would need to hold their OAC for scheduled surgery. Especially for warfarin, this process is complex and requires multi-layer risk assessment and decisions across different specialties. Clinical guidelines deliver broad recommendations in the area of warfarin management before surgery which can lead to different trends and practices among practitioners. To evaluate the current attitude, awareness, and practice among health care providers (HCPs) on warfarin periprocedural management. A multiple-choice questionnaire was developed, containing questions on demographics and professional information and was completed by187 HCPs involved in warfarin periprocedural management. The awareness median (IQR) score was moderate [64.28% (21.43)]. The level of awareness was associated with the practitioner’s specialty and degree of education (P = 0.009, 0.011 respectively). Practice leans to overestimate the need for warfarin discontinuation as well as the need for bridging. Participants expressed interest in using genetic tests to guide periprocedural warfarin management [median (IQR) score (out of 10) = 7 (5)]. In conclusion, the survey presented a wide variation in the clinical practice of warfarin periprocedural management. This study highlights that HCPs in Qatar have moderate awareness. We suggest tailoring an educational campaign or courses towards the identified gaps.
Highlights
Oral anticoagulants (OAC) have been used for years in the treatment and prevention of thromboembolism [1, 2]
In a recent study in Qatar, a similar level of awareness was achieved among health care providers (HCPs) on direct oral anticoagulants (DOACs) [13]
This is surprising given the fact that a clear recommendation in the 2017 American College of Cardiology (ACC) guideline states that, warfarin should be held 5–7 days before an elective procedure [9]
Summary
Oral anticoagulants (OAC) have been used for years in the treatment and prevention of thromboembolism [1, 2]. The Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) trial showed that the composite outcome of systemic embolism or stroke, myocardial infarction, bleeding or hospitalization was elevated in the bridging arm significantly [8]. Both studies augment the uncertainty of the need for bridging. Most of the guidelines stratify the risk of thromboembolism and procedural bleeding risk into high and low, to facilitate the interruption decision [6] These classifications have some drawbacks, such as procedures with a low rate of bleeding, but with severe consequences. There is a disagreement regarding the classification of some procedures such as hip/ knee replacement and prostate biopsy [9]
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