PB1074 - Global prevalence of anticoagulant reversal for major bleeding and urgent surgery in patients with atrial fibrillation and venous thromboembolism: a systematic review of data from 38 countries

Background: Direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) are used for long-term prevention and management of venous thromboembolism (VTE) in patients with atrial fibrillation (AF). Reversal of these agents is critical in instances of major bleeding and urgent surgery.

Aims: To determine the prevalence of DOAC/VKA reversal for major bleeding and urgent surgery in patients with AF/VTE.

Methods: A systematic search of PubMed, MEDLINE and Embase was conducted for retrospective and prospective studies including systematic reviews and meta-analyses reporting DOAC/VKA reversal for patients with AF/VTE between January 2010 and June 2023. Articles were screened and assessed at title/abstract and full-text levels by three independent reviewers. Prevalences of DOAC/VKA reversal were calculated using country-specific estimations where available, and extrapolated based on parameters including geography, healthcare systems and risk factors in the absence of such data. Estimates were also projected over a 10-year period to 2033. This study was funded by Takeda.

Results: Ninety-one articles (AF, n=56; VTE, n=35) from 38 countries were eligible for analysis. In 2023, the estimated prevalence of AF diagnosis was 51,885,611 (~1.5% of the global population). Approximately 67% of AF patients received DOACs, of which ~3% were eligible for reversal due to major bleeding; 16% of AF patients received VKAs, of which ~5% were eligible for reversal due to major bleeding. Estimated VTE incidence was 3,570,024 in 2023. Among patients experiencing VTE, 78% and 12% were treated with DOACs and VKAs, respectively; ~2% of each group were eligible for reversal due to major bleeding. Ten-year projections estimated an increase in DOAC-treated AF/VTE cases, and a reduction in VKA-treated cases. Data for urgent surgery will be presented.

Conclusion(s): Data indicate a shift towards DOACs as standard of care for patients with AF/VTE. Predicted increase in DOAC use highlights their importance for preventative care, and the need for effective anticoagulant reversal strategies.