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Substantial impact of temporary interruptions of warfarin versus DOAC

Dr Malini Madhavan, Mayo Clinic, USA
ACC 2019

Results from the ORBIT-AF registry have shown that the International Normalised Ratio (INR) is not therapeutic following temporary interruption of warfarin in roughly 50% of the patients at 2 weeks. Interruption of warfarin is also associated with low time in therapeutic range (TTR) for more than 6 months after the interruption. Additionally, temporary interruption of warfarin is associated with a higher incidence of adverse cardiovascular events when compared with a direct oral anticoagulant (DOAC) [1].

It might be necessary for patients with atrial fibrillation (AF) to temporarily interrupt their oral anticoagulation, for example when undergoing a surgical procedure. In the case of warfarin, this may result in an INR that is subtherapeutic for some days after re-initiation, which may lead to an increase in thromboembolic events. For DOAC this is different as patients on these drugs attain therapeutic OAC as soon as the drug is restarted, which may result in a lower risk ...

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