Safety of Hepatobiliary and Pancreatic Surgery in Patients Receiving Direct oral Anticoaulants (DOACs)

Takahisa Fujikawa, Akira Tanaka


Background: The safety and optimal perioperative management of patients receiving direct oral anticoagulants (DOACs) during hepatobiliary and pancreatic (HBP) surgery is still controversial.

Methods: Between 2012 and 2018, 115 anticoagulant-prescribed patients who underwent elective HBP surgery (65 benign and 50 malignant diseases, 69 laparoscopic and 46 open-fashioned operations) in our department were enrolled in this study. Patients undergoing emergency operations were excluded from the study. The patients were divided into two groups; patients receiving DOACs (DOAC group, n=35) and patients undergoing warfarin therapy (WF group, n=80). Background characteristics, surgical blood loss, and postoperative complications, including bleeding and thrombotic complications, were compared between the groups.

Results: In the DOAC group, dabigatran, apixaban, rivaroxaban, and edoxaban were used in 10, 8, 10, and 7 patients, respectively, and only 11 patients (31.4%) received perioperative heparin bridging. There were no differences in patients’ background characteristics and mode of surgery (open or laparoscopic). The duration of operation (P=0.148), surgical blood loss (P=0.782), and the rate of intraoperative red blood cell transfusion (P=1.000) were similar between the groups. Overall, any thromboembolic complications were not observed in the current cohort, and only 1 patient (2.9%) suffered from postoperative bleeding complication in the DOAC group. The mortality was zero, and the length of postoperative stay was also identical between the groups (P=0.998).

Conclusion: HBP surgery is safely performed in patients receiving DOAC therapy, without increase in bleeding or thromboembolic complications compared with warfarin therapy.


Direct oral anticoagulant (DOAC); Hepatobiliary and pancreatic surgery; Anticoagulation therapy; Bleeding complication; Thromboembolic complication

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