LAUSR

BACKGROUND Therapeutic anticoagulation with either a vitamin K antagonist (VKA) or direct anticoagulant (DOAC) is often newly prescribed to patients undergoing lower extremity bypass (LEB) to aid in graft patency when risk factors for thrombosis are present or to treat postoperative venous thromboembolism or atrial fibrillation. There is a gap in knowledge as to how DOAC usage impacts post operative outcomes compared to the standard of care VKAs. STUDY DESIGN To determine temporal trends in DOAC prescription following infrainguinal LEB, impact on length of stay (LOS), and associated bleeding and thrombotic complications, patients undergoing elective LEB were identified from the Vascular Quality Initiative (VQI) between January 2013 and May 2019. Postoperative bleeding, LOS, and graft occlusion for patients receiving VKA compared to DOAC were evaluated. RESULTS 24,459 LEBs were performed during the study period. Among 2,656 patients newly prescribed an anticoagulant, 78.0% (n=2,072) received VKA and 22.0% (n=584) received a DOAC, with DOAC utilization increasing throughout the study period. There was no significant difference in postoperative bleeding (VKA 2.3%, DOAC 1.7%, p=0.413) or graft occlusion (VKA 1.2%, DOAC 1.4%, p=0.762) between the anticoagulant classes. LOS was shorter in the DOAC group compared to the VKA group (5.7 vs. 6.8 days; p<.001). CONCLUSIONS This analysis demonstrates that DOAC use is increasing over time in VQI centers, and that they are a safe and comparable alternative to VKAs in the postoperative setting with similar rates of bleeding complications and early graft patency and are associated with a reduced post-operative LOS.