PERIXa Protocol safe and reasonable for perioperative anticoagulation among AF Patients: JAMA
Researchers have found in a cohort study that patients with atrial fibrillation (AF) receiving a factor Xa inhibitor and undergoing procedures with minimal to low bleeding risk had low rates of major bleeding and thromboembolism when managed with the standardized PERIXa protocol for perioperative anticoagulation. These findings suggest that the PERIXa protocol may be a safe and reasonable approach for this patient population. This study was published in the journal JAMA Network Open by So-Ryoung and fellow researchers.
This was a prospective, multicenter, single-arm cohort study carried out from September 2020 to April 2024. In the modified intention-to-treat analysis, 1,902 patients with AF were selected for the procedure who had minimum to low risk of bleeding. According to the PERIXa protocol, it was suggested to discontinue the factor Xa inhibitors 24 hours prior to the procedure and administer on the day of the procedure itself.
Key Findings
• A total of 1,902 patients were included in the modified intention-to-treat analysis.
• Mean (SD) age: 70.4 (8.8) years.
• Male patients: 1,135 (59.7%).
• Mean (SD) CHA₂DS₂-VASc score: 2.8 (1.3).
• Mean (SD) HAS-BLED score: 1.6 (0.7).
Anticoagulant usage:
• Apixaban: 921 patients (48.4%).
• Edoxaban: 616 patients (32.4%).
• Rivaroxaban: 365 patients (19.2%).
Types of procedures:
• Endoscopy: 948 procedures (49.8%).
• Dental procedures: 820 procedures (43.1%).
• Ocular surgery: 120 procedures (6.3%).
• 30-day major bleeding event rate: 0.1% (2 cases).
No thromboembolic events were reported.
The study authors concluded that patients with AF undergoing procedures at minimal to low risk of bleeding, low rates of major bleeding and no thromboembolic events were experienced when following the PERIXa protocol.
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