Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry

Eur Heart J. 2014 Jul 21;35(28):1888-96. doi: 10.1093/eurheartj/eht557. Epub 2014 Jan 6.


Aims: Patients receiving novel oral anticoagulants (NOACs) frequently undergo interventional procedures. Short half-lives and rapid onset of action allow for short periods of NOAC interruption without heparin bridging. However, outcome data for this approach are lacking. We evaluated the peri-interventional NOAC management in unselected patients from daily care.

Methods and results: Effectiveness and safety data were collected from an ongoing, prospective, non-interventional registry of >2100 NOAC patients. Outcome events were adjudicated using standard event definitions. Of 2179 registered patients, 595 (27.3%) underwent 863 procedures (15.6% minimal, 74.3% minor, and 10.1% major procedures). Until Day 30 ± 5 post-procedure, major cardiovascular events occurred in 1.0% of patients [95% confidence interval (95% CI) 0.5-2.0] and major bleeding complications in 1.2% (95% CI 0.6-2.1). Cardiovascular and major bleeding complications were highest after major procedures (4.6 and 8.0%, respectively). Heparin bridging did not reduce cardiovascular events, but led to significantly higher rates of major bleeding complications (2.7%; 95% CI 1.1-5.5) compared with no bridging (0.5%; 0.1-1.4; P = 0.010). Multivariate analysis demonstrated diabetes [odds ratio (OR) 13.2] and major procedures (OR 7.3) as independent risk factors for cardiovascular events. Major procedures (OR 16.8) were an independent risk factor for major bleeding complications. However, if major and non-major procedures were separately assessed, heparin bridging was not an independent risk factor for major bleeding.

Conclusion: Continuation or short-term interruption of NOAC is safe strategies for most invasive procedures. Patients at cardiovascular risk undergoing major procedures may benefit from heparin bridging, but bleeding risks need to be considered.

Keywords: Apixaban; Bridging; Dabigatran; Invasive procedures; Oral anticoagulants; Rivaroxaban.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage*
  • Blood Loss, Surgical / statistics & numerical data*
  • Factor Xa Inhibitors / administration & dosage
  • Female
  • Heparin / administration & dosage*
  • Humans
  • Ischemic Attack, Transient / prevention & control
  • Male
  • Middle Aged
  • Perioperative Care / methods
  • Postoperative Hemorrhage / chemically induced*
  • Prospective Studies
  • Registries
  • Risk Factors
  • Stroke / prevention & control
  • Treatment Outcome
  • Venous Thrombosis / prevention & control
  • Young Adult


  • Anticoagulants
  • Factor Xa Inhibitors
  • Heparin