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Original research
Operative survival in patients with acute aortic disease in the era of newer oral anticoagulants
  1. Johannes Lagethon Bjørnstad1,2,
  2. Adil Mahboob Khan1,
  3. Henriette Røed-Undlien2,
  4. Bjørn Bendz2,3,
  5. Ståle Nygård4,
  6. Tom Nilsen Hoel1 and
  7. Per Snorre Lingaas1
  1. 1Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
  2. 2Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  3. 3Department of Cardiology, Oslo University Hospital, Oslo, Norway
  4. 4Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Johannes Lagethon Bjørnstad; johannes.bjornstad{at}


Aims The aim of this study was the analysis of the risk associated with direct oral anticoagulants (DOACs) in patients undergoing non-elective operations on the proximal aorta due to aortic disease.

Methods and results Data from the department’s register of cardiac surgery was analysed retrospectively with emphasis on operative mortality. 135 non-elective operations for proximal aortic disease (October 2016 to 2018) were identified, of which 19 died during the first 90 days. DOAC use was the top-ranked risk factor in the univariate analysis with a HR of 9.6 (3.1 to 29), p=0.00007. Using a Cox proportional hazards model including the most relevant risk factors, the risk associated with DOAC use remained significant with a HR of 6.1 (1.4 to 26.3), p=0.015. We did not find increased risk associated with warfarin use.

Conclusion In patients undergoing non-elective operations on the proximal aorta due to aortic disease, the use of DOAC is associated with increased operative mortality.

  • pharmacology
  • cardiac surgery
  • dissection

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  • Contributors JLB: Project idea, data acquisition, analysis and writing. He is the corresponding author and the one being responsible for the overall content. AMK: Data acquisition, writing/editing assistance. HR-U: Data acquisition, writing/editing assistance. BB: Project idea, writing/editing assistance. SN: Statistical supervisor. TNH: Project idea, data acquisition, writing/editing assistance. PSL: Project idea, data acquisition, writing/editing assistance.

  • Funding This work was supported by Oslo University Hospital.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study complies with the Declaration of Helsinki. The Regional Committees for Medical and Health Research Ethics have approved the research protocol and also waived the need for informed consent due to the nature of the study and according to Norwegian law regulating Health Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Anonymised data may be shared upon reasonable request.

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