Perioperative New Oral Anticoagulant Study

The purpose of this research is to help in the care of people who need to have a surgery or a medical procedure and are receiving a new oral anticoagulant (blood thinner) like dabigatran (Pradaxa), rivaroxaban (Xarelto) or apixaban (Eliquis), in place of warfarin. This situation is common because an increasing number of people are receiving these new blood thinners to prevent a stroke if they have an irregular heart beat (referred to as atrial fibrillation), and many of these people need to stop these drugs before a surgery or procedure. Knowing when to stop and restart these drugs is important so that the risk to a patient of developing bleeding or a stroke is minimized. It is estimated that 400,000 people in North America who are receiving a new blood thinner will need a surgery or procedure each year. The health professionals involved in this research have developed separate protocols for how to best look after patients who are receiving each of the new blood thinners. This protocol will be standardized so all patients are managed according to what is considered the safest approach. However, the protocol is also flexible. For example, individual patients may have different experiences during and after a surgery which will affect how and when blood thinners are resumed. This study will also assess the best way to measure, with blood tests, that the blood thinning effect of these new drugs is no longer present at the time of the surgery. Again, this is done to optimize safety for patients. Without this study, doctors will have challenges in how to best look after patients who need a surgery or procedure. For example, patients may develop more bleeding if these new blood thinners are resumed too early enough after surgery or may be prone to blood clots if these drugs are stopped too soon before a surgery. This study will provide solutions to these challenges.