{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T10:44:33Z","timestamp":1767869073174,"version":"3.49.0"},"reference-count":21,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,26]],"date-time":"2025-01-26T00:00:00Z","timestamp":1737849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bayer"},{"name":"Bristol-Myers Squibb\/Pfizer"},{"name":"Daiichi Sankyo"},{"name":"CSL Behring"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background: Major bleeding or emergency surgery are the most frequently observed emergency situations in patients anticoagulated with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). The restart of anticoagulation after these situations is a therapeutic dilemma. Methods: The prospective RADOA registry is an observational, noninterventional multicenter registry that documents the management of severe bleeding or emergency surgery in patients treated with VKAs or DOACs. In this substudy, we analyzed time point, type, and dosage of anticoagulant resumption after emergency situations. Results: Overall, 78 emergency surgery patients and 193 major bleeding patients were analyzed. Median age was similar in the VKA- and DOAC-treated groups (emergency surgery: 77 years, major bleeding: 79 years). Anticoagulants were restarted significantly earlier after emergency surgery compared to major bleeding, with no difference between the VKA and DOAC groups. While patients after cardiothoracic surgery received UFH intravenously, patients with trauma or having received abdominal surgery were mainly treated with prophylactic LMWH s.c.. After major bleeding, the majority of patients were treated with prophylactic LMWH. None of the patients in the emergency surgery group and 17% (4\/24) of the major bleeding group with recurrent bleeding (12%, 24\/193) experienced recurrent bleeding after restart of anticoagulation. Thromboembolism occurred rarely in both patient groups (emergency surgery: 3%, major bleeding 4%). Conclusions: Time points of restart, type, and dosage of anticoagulants are highly diverse in this high-risk patient population. Resumption of prophylactic anticoagulation is associated with a low risk of thrombosis and should be initiated as soon as possible.<\/jats:p>","DOI":"10.3390\/ph18020170","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T04:59:10Z","timestamp":1737953950000},"page":"170","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Anticoagulant Management After Emergency Surgery or Major Bleeding in Anticoagulated Patients\u2014Results of the Prospective RADOA Registry"],"prefix":"10.3390","volume":"18","author":[{"given":"Jana","family":"Last","sequence":"first","affiliation":[{"name":"Coagulation Research Centre Bethanien Hospital, 63089 Frankfurt, Germany"},{"name":"Deutsches Herzzentrum der Charit\u00e9 (DHZC) Berlin, Department of Cardiology, Angiology and Intensive Care Medicine, Charit\u00e9 Berlin, 12203 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingvild","family":"Birschmann","sequence":"additional","affiliation":[{"name":"Institute for Laboratory and Transfusion Medicine, Heart and Diabetes Centre, Ruhr University, 44801 Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Lindau","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, 60596 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6359-7279","authenticated-orcid":false,"given":"Stavros","family":"Konstantinides","sequence":"additional","affiliation":[{"name":"Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, 55122 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0722-3122","authenticated-orcid":false,"given":"Oliver","family":"Grottke","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, RWTH Aachen University Hospital, 52062 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrike","family":"Nowak-G\u00f6ttl","sequence":"additional","affiliation":[{"name":"Institute of Clinical Chemistry, Thrombosis & Hemostasis Treatment Centre, University Hospital, Kiel-L\u00fcbeck, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Zydek","sequence":"additional","affiliation":[{"name":"Coagulation Research Centre Bethanien Hospital, 63089 Frankfurt, Germany"},{"name":"Coagulation Centre at the Cardiology Angiology Centre Bethanien Hospital (CCB), 63089 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"von Heymann","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, 10249 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Beyer-Westendorf","sequence":"additional","affiliation":[{"name":"Department of Medicine 1, Division of Thrombosis & Hemostasis, Dresden University Clinic, 01307 Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Schellong","sequence":"additional","affiliation":[{"name":"Medical Department 2, Municipal Hospital, 01129 Dresden, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2666-8696","authenticated-orcid":false,"given":"Patrick","family":"Meybohm","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital W\u00fcrzburg, 97080 W\u00fcrzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8343-7336","authenticated-orcid":false,"given":"Andreas","family":"Greinacher","sequence":"additional","affiliation":[{"name":"Institute for Transfusions Medicine, Universit\u00e4tsmedizin Greifswald, 17489 Greifswald, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0662-6675","authenticated-orcid":false,"given":"Eva","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, 60596 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7019-7887","authenticated-orcid":false,"given":"Edelgard","family":"Lindhoff-Last","sequence":"additional","affiliation":[{"name":"Coagulation Research Centre Bethanien Hospital, 63089 Frankfurt, Germany"},{"name":"Coagulation Centre at the Cardiology Angiology Centre Bethanien Hospital (CCB), 63089 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1001\/jama.2021.13844","article-title":"US Emergency Department Visits Attributed to Medication Harms, 2017\u20132019","volume":"326","author":"Budnitz","year":"2021","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.1001\/jama.296.15.1858","article-title":"National surveillance of emergency department visits for outpatient adverse drug events","volume":"296","author":"Budnitz","year":"2006","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1182\/blood-2014-07-590323","article-title":"The impact of bleeding complications in patients receiving target-specific oral anticoagulants: A systematic review and meta-analysis","volume":"124","author":"Crowther","year":"2014","journal-title":"Blood"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.1160\/TH17-08-0553","article-title":"The Perioperative Anticoagulant Use for Surgery Evaluation (PAUSE) Study for Patients on a Direct Oral Anticoagulant Who Need an Elective Surgery or Procedure: Design and Rationale","volume":"117","author":"Douketis","year":"2017","journal-title":"Thromb. Haemost."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s11606-019-05391-y","article-title":"Emergency Visits for Oral Anticoagulant Bleeding","volume":"35","author":"Geller","year":"2020","journal-title":"J. Gen. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s11239-022-02739-w","article-title":"Urgent procedures or surgeries in patients receiving oral anticoagulants: A systematic literature review","volume":"55","author":"Siegal","year":"2023","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_7","first-page":"2","article-title":"Specific antidotes in development for reversal of novel anticoagulants: A review","volume":"9","author":"Lecumberri","year":"2014","journal-title":"Recent Pat. Cardiovasc. Drug Discov."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"6707985","DOI":"10.1155\/2022\/6707985","article-title":"Time Trends and Treatment Pathways in Prescribing Individual Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation: An Observational Study of More than Three Million Patients from Europe and the United States","volume":"2022","author":"Vora","year":"2022","journal-title":"Int. J. Clin. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2987","DOI":"10.1016\/j.jacc.2021.04.061","article-title":"Meta-Analysis of Reversal Agents for Severe Bleeding Associated With Direct Oral Anticoagulants","volume":"77","author":"Alcubilla","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/j.ajem.2019.12.023","article-title":"The safety of oral anticoagulants registry (SOAR): A national, ED-based study of the evaluation and management of bleeding and bleeding concerns due to the use of oral anticoagulants","volume":"38","author":"Pollack","year":"2020","journal-title":"Am. J. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.thromres.2022.06.005","article-title":"Management of urgent invasive procedures in patients treated with direct oral anticoagulants: An observational registry analysis","volume":"216","author":"Godon","year":"2022","journal-title":"Thromb. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1002\/rth2.12336","article-title":"Emergencies on direct oral anticoagulants: Management, outcomes, and laboratory effects of prothrombin complex concentrate","volume":"4","author":"Bavalia","year":"2020","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Last, J., Herrmann, E., Birschmann, I., Lindau, S., Konstantinides, S., Grottke, O., Nowak-Gottl, U., Zydek, B., von Heymann, C., and Sumnig, A. (2024). Clinical Course and Management of Patients with Emergency Surgery Treated with Direct Oral Anticoagulants or Vitamin K Antagonists-Results of the German Prospective RADOA-Registry. J. Clin. Med., 13.","DOI":"10.3390\/jcm13010272"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s13017-024-00537-8","article-title":"The 2023 WSES guidelines on the management of trauma in elderly and frail patients","volume":"19","author":"Chouillard","year":"2024","journal-title":"World J. Emerg. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Menditto, V.G., Rossetti, G., Sampaolesi, M., Buzzo, M., and Pomponio, G. (2024). Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department. J. Clin. Med., 13.","DOI":"10.3390\/jcm13133669"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1038\/nrcardio.2017.223","article-title":"Reversal agents for non-vitamin K antagonist oral anticoagulants","volume":"15","author":"Levy","year":"2018","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"257","DOI":"10.5482\/HAMO-16-11-0043","article-title":"Direct oral anticoagulants (DOAC)\u2014Management of emergency situations","volume":"37","year":"2017","journal-title":"Hamostaseologie"},{"key":"ref_18","first-page":"312","article-title":"Severe Hemorrhage Associated with Oral Anticoagulants","volume":"117","author":"Herrmann","year":"2020","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lindhoff-Last, E., Birschmann, I., Bidenharn, A.J., Kuhn, J., Lindau, S., Konstantinides, S., Grottke, O., Nowak-Gottl, U., Lucks, J., and Zydek, B. (2022). Pharmacokinetics of Phenprocoumon in Emergency Situations-Results of the Prospective Observational RADOA-Registry (Reversal Agent Use in Patients Treated with Direct Oral Anticoagulants or Vitamin K Antagonists Registry). Pharmaceuticals, 15.","DOI":"10.3390\/ph15111437"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s42466-022-00183-y","article-title":"Intracranial bleeding under vitamin K antagonists or direct oral anticoagulants: Results of the RADOA registry","volume":"4","author":"Pfeilschifter","year":"2022","journal-title":"Neurol. Res. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1055\/a-1549-6556","article-title":"Pharmacokinetics of Direct Oral Anticoagulants in Emergency Situations: Results of the Prospective Observational RADOA-Registry","volume":"122","author":"Birschmann","year":"2022","journal-title":"Thromb. Haemost."}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/18\/2\/170\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:36:51Z","timestamp":1759919811000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/18\/2\/170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,26]]},"references-count":21,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["ph18020170"],"URL":"https:\/\/doi.org\/10.3390\/ph18020170","relation":{},"ISSN":["1424-8247"],"issn-type":[{"value":"1424-8247","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,26]]}}}