scholarly journals Safety and efficacy of a strategy of vitamin K antagonist reversal with prothrombin complex concentrates compared to vitamin K in patients with hip fracture

2021 ◽  
Vol 64 (3) ◽  
pp. E330-E338
Author(s):  
Lucille Jay-Caillierez ◽  
Arnaud Friggeri ◽  
Anthony Viste ◽  
Mathilde Lefevre ◽  
Evelyne Decullier ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Vitamin K ◽  
Study Groups ◽  
Hospital Length ◽  
Vitamin K Antagonist ◽  
Hospital Length Of Stay ◽  
Red Blood Cell Transfusion ◽  
Control Group ◽  
Number Of Patients ◽  
Hemorrhagic Complications

Background: Increased preoperative delay in patients with hip fractures may be responsible for increased morbidity and mortality. We hypothesized that a strategy of reversal of vitamin K antagonist (VKA) by prothrombin complexes concentrates (PCCs), as compared to vitamin K, is safe and reduces preoperative delay and hospital length of stay (LOS). Methods: In this pilot study, we reviewed the records of patients admitted to a university-affiliated hospital for hip fracture between Jan. 1, 2012, and Dec. 31, 2016, who were taking VKA. Patients were stratified according to reversal strategy (vitamin K v. PCC). Adverse effects, time to surgery, LOS and mortality were collected from the electronic medical record and were compared between the 2 study groups and a control group not treated with VKA. Results: A total of 141 patients were included in the study: 65 in the vitamin K group, 26 in the PCC group and 50 in the control group. The median preoperative delay in the PCC group (20 h [interquartile range (IQR)] 13–25 h]) and the control group (20 h [IQR 15–33 h]) was lower than that in the vitamin K group (45 h [IQR 31–52 h]) (p < 0.001). Patients in the PCC group had a shorter median hospital LOS than those in the vitamin K group (6 d [IQR 4–9 d] v. 8 d [IQR 6–11 d], p < 0.05). No difference was observed in the proportion of patients who received a red blood cell transfusion, or had thrombotic or hemorrhagic complications. No difference in mortality at 12 months was observed between the groups. Conclusion: In patients with hip fracture, the use of PCCs as compared to vitamin K to reverse the effect of VKA significantly reduced preoperative delay and hospital LOS, and was not associated with an increase in the rates of thrombotic or hemorrhagic complications. Prospective studies involving a greater number of patients are required to confirm these promising results.

Effect of Adjunctive Dexmedetomidine in the Treatment of Alcohol Withdrawal Compared to Benzodiazepine Symptom-Triggered Therapy in Critically Ill Patients: The EvADE Study

2020 ◽  
pp. 089719002097775
Author(s):  
Tia E. Collier ◽  
Lane B. Farrell ◽  
Aaron D. Killian ◽  
Vivek K. Kataria
Keyword(s):  
Alcohol Withdrawal ◽  
Alcohol Withdrawal Syndrome ◽  
Study Groups ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Physical Restraints ◽  
Significant Difference ◽  
Propensity Matching ◽  
New Onset

Objective: This study evaluated the safety and efficacy of adjunctive dexmedetomidine for alcohol withdrawal syndrome (AWS) treatment compared to symptom-triggered benzodiazepine therapy. Methods: This single-center, retrospective, cohort study evaluated patients admitted to an intensive care unit (ICU) with AWS. Patients were divided into 2 groups: adjunctive dexmedetomidine or symptom-triggered therapy (control). Primary outcome was change in Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) score. Secondary outcomes assessed cumulative ICU benzodiazepine requirement and ICU/hospital length of stay (LOS). Safety outcomes evaluated incidence of adverse events, new onset seizures, and intubation. Propensity matching was performed to minimize differences between study groups. Results: Overall, 147 patients were included, 56 in the dexmedetomidine group and 91 in the control group. Patient demographics were similar, however baseline CIWA-Ar score was statistically higher in the dexmedetomidine group. Following propensity matching, 55 patients were included in each group. No significant difference was noted for change in CIWA-Ar score (median, IQR) [3.8 (-0.4-12.3) dexmedetomidine vs. 5.4 (1.4-12.9) control, p = 0.223]. Secondary endpoints revealed increased benzodiazepine requirements (p = 0.001), prolonged ICU LOS (p = 0.050), and more frequent use of physical restraints (p = 0.001) in the dexmedetomidine group. While not statistically significant, the development of new onset seizures (p = 0.775) and intubation (p = 0.294) occurred more frequently in the dexmedetomidine group. Conclusion: The addition of dexmedetomidine to symptom-triggered benzodiazepines for AWS did not produce a significant change in CIWA-Ar scores from baseline compared to symptom-triggered therapy alone. The increased rate of new onset seizures and intubation warrant further investigation into the safety of dexmedetomidine in AWS.

scholarly journals Implementation of an electronic care pathway for hip fracture patients: a pilot before and after study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Jason Talevski ◽  
Viviana Guerrero-Cedeño ◽  
Oddom Demontiero ◽  
Pushpa Suriyaarachchi ◽  
Derek Boersma ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Outcome Measures ◽  
Care Pathway ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Care Pathways ◽  
Discharge Location

Abstract Background Care pathways are generally paper-based and can cause communication failures between multidisciplinary teams, potentially compromising the safety of the patient. Computerized care pathways may facilitate better communication between clinical teams. This study aimed to investigate whether an electronic care pathway (e-pathway) reduces delays in surgery and hospital length of stay compared to a traditional paper-based care pathway (control) in hip fracture patients. Methods A single-centre evaluation with a retrospective control group was conducted in the Orthogeriatric Ward, Nepean Hospital, New South Wales, Australia. We enrolled patients aged > 65 years that were hospitalized for a hip fracture in 2008 (control group) and 2012 (e-pathway group). The e-pathway provided the essential steps in the care of patients with hip fracture, including examinations and treatment to be carried out. Main outcome measures were delay in surgery and hospital length of stay; secondary outcomes were in-hospital mortality and discharge location. Results A total of 181 patients were enrolled in the study (129 control; 54 e-pathway group). There was a significant reduction in delay to surgery in the e-pathway group compared to control group in unadjusted (OR = 0.19; CI 0.09–0.39; p < 0.001) and adjusted (OR = 0.22; CI 0.10–0.49; p < 0.001) models. There were no significant differences between groups for length of stay (median 11 vs 12 days; p = 0.567), in-hospital mortality (1 vs 7 participants; p = 0.206) or discharge location (p = 0.206). Conclusions This pilot study suggests that, compared to a paper-based care pathway, implementation of an e-pathway for hip fracture patients results in a reduction in total number of delays to surgery, but not hospital length of stay. Further evaluation is warranted using a larger cohort investigating both clinical and patient-reported outcome measures.

scholarly journals The independent patient factors that affect length of stay following hip fractures

2018 ◽  
Vol 100 (7) ◽  
pp. 556-562 ◽  
Author(s):  
T Richards ◽  
A Glendenning ◽  
D Benson ◽  
S Alexander ◽  
S Thati
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Acute Hospital ◽  
Hospital Length Of Stay ◽  
Patient Factors ◽  
Mobility Status

Introduction Management of hip fractures has evolved over recent years to drive better outcomes including length of hospital stay. We aimed to identify and quantify the effect that patient factors influence acute hospital and total health service length of stay. Methods A retrospective observational study based on National Hip Fracture Database data was conducted from 1 January 2014 to 31 December 2015. A multiple regression analysis of 330 patients was carried out to determine independent factors that affect acute hospital and total hospital length of stay. Results American Society of Anesthesiologists (ASA) grade 3 or above, Abbreviated Mental Test Score (AMTS) less than 8 and poor mobility status were independent factors, significantly increasing length of hospital stay in our population. Acute hospital length of stay can be predicted as 8.9 days longer when AMTS less than 8, 4.2 days longer when ASA grade was 3 or above and 20.4 days longer when unable to mobilise unaided (compared with independently mobile individuals). Other factors including total hip replacement compared with hemiarthroplasty did not independently affect length of stay. Conclusions Our analysis in a representative and generalisable population illustrates the importance of identifying these three patient characteristics in hip fracture patients. When recognised and targeted with orthogeriatric support, the length of hospital stay for these patients can be reduced and overall hip fracture care improved. Screening on admission for ASA grade, AMTS and mobility status allows prediction of length of stay and tailoring of care to match needs.

scholarly journals Hip Fractures in Centenarians: Has Care Improved in the National Hip Fracture Database Era?

2017 ◽  
Vol 8 (3) ◽  
pp. 161-165 ◽  
Author(s):  
Alastair G. Dick ◽  
Dominic Davenport ◽  
Mohit Bansal ◽  
Therese S. Burch ◽  
Max R. Edwards
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
District General Hospital ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Retrospective Case ◽  
Time To Surgery ◽  
Surgery Mortality ◽  
Hospital Acquired

Introduction: The number of centenarians in the United Kingdom is increasing. An associated increase in the incidence of hip fractures in the extreme elderly population is expected. The National Hip Fracture Database (NHFD) initiative was introduced in 2007 aiming to improve hip fracture care. There is a paucity of literature on the outcomes of centenarians with hip fractures since its introduction. The aim of this study is to report our experience of hip fractures in centenarians in the era since the introduction of the NHFD to assess outcomes in terms of mortality, time to surgery, length of stay, and complications. Methods: A retrospective case note study of all centenarians managed for a hip fracture over a 7-year period at a London district general hospital. Results: We report on 22 centenarians sustaining 23 hip fractures between 2008 and 2015. Twenty-one fractures were managed operatively. For patients managed operatively, in-hospital, 30-day, 3-month, 6-month, 1-year, 2-year, 3-year, and 5-year cumulative mortalities were 30%, 30%, 39%, 50%, 77%, 86%, 95%, and 100%, respectively. In-hospital mortality was 100% for those managed nonoperatively. Mean time to surgery was 1.6 days (range: 0.7-6.3 days). Mean length of stay on the acute orthopedic ward was 23 days (range: 2-51 days). Seventy-one percent had a postoperative complication most commonly a hospital-acquired pneumonia or urinary tract infection. Conclusion: Compared to a series of centenarians with hip fractures prior to the introduction of the NHFD, we report a reduced time to surgery. Mortality and hospital length of stay were similar.

Controlled Study of Decision-Making Algorithms for Kidney Replacement Therapy Initiation in Acute Kidney Injury

2021 ◽  
pp. CJN.02060221
Author(s):  
Yvelynne Kelly ◽  
Kavita Mistry ◽  
Salman Ahmed ◽  
Shimon Shaykevich ◽  
Sonali Desai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Controlled Study ◽  
Control Group ◽  
Inpatient Mortality ◽  
Icu Length Of Stay ◽  
Kidney Replacement Therapy

Background: Acute kidney injury (AKI) requiring kidney replacement therapy (KRT) is associated with high mortality and utilization. We evaluated the use of an AKI-Standardized Clinical Assessment and Management Plan (SCAMP) on patient outcomes including mortality, hospital and ICU length of stay. Methods: We conducted a 12-month controlled study in the ICUs of a large academic tertiary medical center. We alternated use of the AKI-SCAMP with use of a "sham" control form in 4-6-week blocks. The primary outcome was risk of inpatient mortality. Pre-specified secondary outcomes included 30-day mortality, 60-day mortality and hospital and ICU length of stay. Generalized estimating equations were used to estimate the impact of the AKI-SCAMP on mortality and length of stay. Results: There were 122 patients in the AKI-SCAMP group and 102 patients in the control group. There was no significant difference in inpatient mortality associated with AKI-SCAMP use (41% vs 47% control). AKI-SCAMP use was associated with significantly reduced ICU length of stay (mean 8 (95% CI 8-9) vs 12 (95% CI 10-13) days; p = <0.0001) and hospital length of stay (mean 25 (95% CI 22-29) vs 30 (95% CI 27-34) days; p = 0.02). Patients in the AKI-SCAMP group less likely to receive KRT in the context of physician-perceived treatment futility than those in the control group (2% vs 7%, p=0.003). Conclusions: Use of the AKI-SCAMP tool for AKI-KRT was not significantly associated with inpatient mortality but was associated with reduced ICU and hospital length of stay and use of KRT in cases of physician-perceived treatment futility.

scholarly journals A Implementation of Antibiotic Prophylaxis Program for Cesarean Section at Thai Nguyen National Hospital

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Nguyen Thi Thu Thuy ◽  
Nguyem Thanh Hai ◽  
Nguyem Xuan Bach ◽  
Hoang Thi Thu Huong ◽  
Nguyem Chi Cuong ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Antibiotic Prophylaxis ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Viet Nam ◽  
National Hospital ◽  
Ministry Of Health

This study aims to evaluate the effectiveness of the use of antibiotic prophylaxis in cesarean section at Thai Nguyen National Hospital as a first pilot activity of a surgical prophylaxis program. In the study, a randomized controlled trial was designed with two groups: intervention group and control group. Patients characteristics and effectiveness of prophylactic antibiotics for caesarean section were compared. The study results show that the patients’ ages ranged from 18 to 44 years; most of the patients had ASA score of 1; and mean hospital length of stay was statistically significant between the two groups (p<0.05). Regarding the indication of caesarean section, the reason of genital tract abnormalities accounted for the highest proportion. The percentage of the patients switching from prophylactic antibiotic regimens to therapeutic antibiotics in the intervention group was 2%. There was no patient with superficial and/or deep incisional surgical site infections in both groups. The difference in mean number of injections in the two groups was statistically significant (p<0.05). The average cost of antibiotics for each patient in the intervention group and control group were 267.720 VND and 543.871 VND, respectively. The study concludes that the effectiveness of antibiotics prophylaxis for caesarean section: 99% of the patients were without wound infection; hospital length of stay in the intervention group was shorter than the control group; and using prophylactic antibiotics was not only more economical but could also reduce the workload of medical staff, costs of antibiotics and medical supplies. Keywords  Antibiotics prophylaxis, caesarean section, Thai Nguyen National Hospital. References [1] Viet Nam Ministry of Health, National guideline on prevention of surgical site infection, issued with Decision No. 3671/QD-BYT, September 27, 2012 of Viet Nam Ministry of Health, Ha Noi, 2012 (in Vietnamese).[2] Viet Nam Ministry of Health, National guideline on antibiotics use, issued with Decision No.708/QD-BYT, March 2, 2015 of Viet Nam Ministry of Health, Ha Noi, 2015 (in Vietnamese).[3] D.W. Bratzler, K.M. Olsen, et al., Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery, American Journal of Health-System Pharmacy 70 (2013) 195 – 283. https://doi.org/10.2146/ajhp120568.[4] R.F. Lamont, J.D. Sobel, et al., Current debate on the use of antibiotic prophylaxis for caesarean section, BJOG: An International Journal of Obstetrics & Gynaecology 118 (2011) 193-201. https://doi.org/10.1111/j.14710528.2010.02729.x.[5] T.V. Khai, Infection rate of surgical incisions and associated factors on women after cesarean section at Dong Nai General Hospital, Scientific Research Project of Dong Nai Hospital, 2015 (in Vietnamese).[6] N.H. Tuan, Study on the use of cefazolin to prevent infection after cesarean section or uterine fibroids surgery at the Institute of maternal and neonatal protection, Master’s thesis, Hanoi University of Pharmacy, 2002 (in Vietnamese).[7] F.M. Smaill, R.M. Grivell, Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section, Cochrane Database Syst Rev 10 (2014) CD007482. https://doi.org/10.1002/14651858.cd007482.pub3.    

Correlation of non-vitamin K antagonist oral anticoagulant exposure and cerebral microbleeds in Chinese patients with atrial fibrillation

2018 ◽  
Vol 89 (7) ◽  
pp. 680-686 ◽  
Author(s):  
Yannie Soo ◽  
Jill Abrigo ◽  
Kam Tat Leung ◽  
Wenyan Liu ◽  
Bonnie Lam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
White Matter ◽  
Vitamin K ◽  
Intracerebral Haemorrhage ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Cerebral Microbleeds ◽  
Chinese Patients ◽  
Control Group

Background and purposeCerebral microbleeds (CMBs) are radiological markers which predict future intracerebral haemorrhage. Researchers are exploring how CMBs can guide anticoagulation decisions in atrial fibrillation (AF). The purpose of this study is to evaluate the correlation of non-vitamin K antagonist oral anticoagulants (NOAC) exposure and prevalence of CMBs in Chinese patients with AF.MethodsWe prospectively recruited Chinese patients with AF on NOAC therapy of ≥30 days for 3T MRI brain for evaluation of CMBs and white matter hyperintensities. Patients with AF without prior exposure to oral anticoagulation were recruited as control group.ResultsA total of 282 patients were recruited, including 124 patients in NOAC group and 158 patients in control group. Mean duration of NOAC exposure was 723.8±500.3 days. CMBs were observed in 103 (36.5%) patients. No significant correlation was observed between duration of NOAC exposure and quantity of CMBs. After adjusting for confounding factors (ie, age, hypertension, labile hypertension, stroke history and white matter scores), previous intracerebral haemorrhage was predictive of CMBs (OR 15.28, 95% CI 1.81 to 129.16), particularly lobar CMBs (OR 5.37, 95% CI 1.27 to 22.6). While white matter score was predictive of mixed lobar CMBs (OR 1.65, 95% CI 1.1 to 2.5), both exposure and duration of NOAC use were not predictive of presence of CMBs.ConclusionsIn Chinese patients with AF, duration of NOAC exposure did not correlate with prevalence and burden of CMBs. Further studies with follow-up MRI are needed to determine if long-term NOAC therapy can lead to development of new CMBs.

663 Application and Management of Cultured Epithelial Autografts (CEAs) on Posterior Burns – A 5-year, Multi-center, Retrospective Review of Outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S187-S187
Author(s):  
Bounthavy Homsombath ◽  
Zaheed Hassan ◽  
Shawn P Fagan ◽  
Beretta C Coffman
Keyword(s):  
Graft Loss ◽  
Hospital Length ◽  
Cost Of Care ◽  
Hospital Length Of Stay ◽  
Anatomical Location ◽  
Number Of Patients ◽  
Posterior Trunk ◽  
Specific Care ◽  
Cultured Epithelial Autografts ◽  
Wound Bed Preparation

Abstract Introduction In patients with larger burns, treatment with CEAs have proven to increase survival.1 CEAs, while useful, are not without some disadvantages. For instance, if the injury involves burns to posterior surfaces, the challenge is inherent in that these fragile sheets are easily sheared, and pressure can cause disruption and graft loss. CEA grafting must be managed with specific care and with specialized protocols that help address these challenges. Graft loss due to these and other factors can delay healing, increase hospital length of stay, and increase the cost of care. The purpose of this study is to evaluate the success for graft take in patients with posterior burns treated with CEA and to discuss the techniques, protocols and approaches to managing these patients within our burn network. Methods This retrospective study was granted exemption by IntegReview IRB. Take rate for each application of CEA was not always found for some cases. For purposes of this study, we agreed with methods of other researchers in the literature and adapted the “clinically relevant” assessment that take and final coverage was successful when re-grafting was not required by the time of discharge or death.2 Results Study dates was March 2016 - December 2019 and at this time, is being reported from among 3 of 6 participating centers. Our approach is to provide CEA prep the day before initial placement and then to ensure strict protocols are followed at the bedside post-op and thereafter. Total number of patients considered was 68, 41 were deemed evaluable. See tables for other demographics and results. 31 patients were discharged to rehab (75%), 6 were discharged home (15%) and 4 died (10%). Conclusions Meticulous attention to wound bed preparation and ensuring that post-op care is clearly stated and understood by all clinicians involved in the care of patients with larger burns with posterior trunk involvement is the key to successful coverage with CEA to this challenging anatomical location.

Daily Interruption of Sedation with Physical and Occupational Therapy in Mechanically Ventilated Patients

2018 ◽  
pp. 309-316
Author(s):  
Michael Wolfe ◽  
Daniel Saddawi-Konefka
Keyword(s):  
Occupational Therapy ◽  
Functional Status ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Schweickert et al. studied effects of early physical and occupational therapy in mechanically ventilated patients. 109 mechanically ventilated medical ICU patients (with independent functional status prior to hospitalization) were randomized to receive physical and occupational therapy initiated at time of enrollment (intervention group) vs. physical and occupational therapy ordered at the discretion of the primary team (control group), with both groups receiving daily interruptions of sedation. The primary outcome, independent functional status at time of discharge, was met in 59% of the intervention group vs. 35% of the control group (p = 0.02). Lower rates of ICU and hospital delirium were observed in the intervention group. Hospital length of stay and mortality were unaffected. This study demonstrated that physical and occupational therapy can be safely accomplished in critically ill, mechanically ventilated medical ICU patients, and that early implementation of therapy may improve return to independent functional status at hospital discharge.

scholarly journals Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 308 ◽  
Author(s):  
Gabriele Savioli ◽  
Iride Francesca Ceresa ◽  
Sabino Luzzi ◽  
Cristian Gragnaniello ◽  
Alice Giotta Lucifero ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Trauma ◽  
Intracranial Hemorrhage ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Mortality Rates ◽  
Control Group ◽  
Number Of Patients ◽  
Blunt Head Trauma ◽  
Significant Difference

Background and objectives: Anticoagulants are thought to increase the risks of traumatic intracranial injury and poor clinical outcomes after blunt head trauma. The safety of using direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) after intracranial hemorrhage (ICH) is unclear. This study aims to compare the incidence of post-traumatic ICH following mild head injury (MHI) and to assess the need for surgery, mortality rates, emergency department (ED) revisit rates, and the volume of ICH. Materials and Methods: This is a retrospective, single-center observational study on all patients admitted to our emergency department for mild head trauma from 1 January 2016, to 31 December 2018. We enrolled 234 anticoagulated patients, of which 156 were on VKAs and 78 on DOACs. Patients underwent computed tomography (CT) scans on arrival (T0) and after 24 h (T24). The control group consisted of patients not taking anticoagulants, had no clotting disorders, and who reported an MHI in the same period. About 54% in the control group had CTs performed. Results: The anticoagulated groups were comparable in baseline parameters. Patients on VKA developed ICH more frequently than patients on DOACs and the control group at 17%, 5.13%, and 7.5%, respectively. No significant difference between the two groups was noted in terms of surgery, intrahospital mortality rates, ED revisit rates, and the volume of ICH. Conclusions: Patients with mild head trauma on DOAC therapy had a similar prevalence of ICH to that of the control group. Meanwhile, patients on VKA therapy had about twice the ICH prevalence than that on the control group or patients on DOAC, which remained after correcting for age. No significant difference in the need for surgery was determined; however, this result must take into account the very small number of patients needing surgery.

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