JAMA Internal Medicine JANUARY 01, 2019

Perioperative Anticoagulant Use for Surgery Evaluation (PAUSE) Study

James D. Douketis, Alex C. Spyropoulos, et al.

Bottom Line

The PAUSE study demonstrated that a standardized, simple perioperative management protocol for direct oral anticoagulants (DOACs)—involving fixed interruption intervals based on procedure bleeding risk and renal function—achieved low rates of major bleeding and arterial thromboembolism without the need for preoperative laboratory testing or heparin bridging.

Key Findings

1. The standardized PAUSE protocol resulted in low rates of major bleeding: 1.35% for apixaban, 0.90% for dabigatran, and 1.85% for rivaroxaban.
2. Arterial thromboembolic event rates were similarly low, remaining below 1% across all drug cohorts.
3. A high proportion of patients achieved minimal or no residual anticoagulant effect (defined as <50 ng/mL) at the time of procedure: 90% overall, and 98.8% in patients undergoing high-bleeding-risk procedures.
4. The protocol successfully facilitated a standardized, simplified approach that eliminates the need for complex heparin bridging strategies or routine preoperative coagulation monitoring.

Study Design

Design
Prospective Cohort Study
Blinded-Endpoint
Sample
3,007
Patients
Duration
30 days
Median
Setting
Multicenter, North America and Europe
Population Patients with atrial fibrillation receiving a DOAC (apixaban, dabigatran, or rivaroxaban) requiring interruption of anticoagulation for an elective surgery or procedure.
Intervention A standardized, patient-specific protocol consisting of fixed-interval DOAC interruption (1 day pre-procedure for low-risk, 2 days for high-risk) and resumption, without preoperative heparin bridging or routine coagulation testing.
Comparator None (Prospective cohort)
Outcome Major bleeding and arterial thromboembolic events within 30 days post-procedure.

Study Limitations

The study used a prospective cohort design rather than a randomized controlled trial, which may be subject to selection bias.
Patients with severe renal impairment (CrCl <25-30 mL/min) were excluded, limiting the generalizability of these findings to patients with advanced chronic kidney disease.
The study focused exclusively on patients with atrial fibrillation, and results may not be directly applicable to patients on DOACs for other indications like venous thromboembolism.
There was a relatively low representation of patients undergoing neuraxial anesthesia, requiring caution when applying the protocol in that specific clinical context.

Clinical Significance

The PAUSE protocol provides a validated, evidence-based standard of care that simplifies the perioperative management of DOACs. By demonstrating safety without the need for bridging anticoagulation or preoperative testing, this strategy reduces healthcare complexity, minimizes costs, and clarifies the management for clinicians and patients.

Historical Context

Prior to the PAUSE study, the perioperative management of DOACs was characterized by significant heterogeneity and uncertainty, often involving the suboptimal adoption of warfarin-style 'bridging' protocols. The PAUSE trial was initiated to establish a standardized, safer, and more efficient evidence-based approach that acknowledges the unique pharmacokinetic profiles of the DOAC agents.

Guided Discussion

High-yield insights from every perspective

Med Student
Medical Student

The PAUSE study demonstrated that heparin bridging is generally unnecessary for patients on Direct Oral Anticoagulants (DOACs). Based on the pharmacokinetics of DOACs compared to warfarin, why is the 'bridge' with a shorter-acting agent like Lovenox considered essential for high-risk warfarin patients but detrimental for those on DOACs?

Key Response

Warfarin has a long half-life (~36-42 hours) and its effects take days to wash out and days to restart, creating a 'thromboembolic gap.' In contrast, DOACs have predictable, short half-lives (12-17 hours) and rapid onset. Adding a bridge to DOACs doesn't significantly narrow the sub-therapeutic window but does substantially increase the 'area under the curve' for bleeding risk, as evidenced by the low 0.4-0.6% arterial thromboembolism rate in PAUSE without bridging.

Resident
Resident

In the PAUSE protocol, the timing of DOAC interruption is dictated by the procedure's bleeding risk. How should a resident classify a laparoscopic cholecystectomy versus a spinal anesthetic procedure under this protocol, and what are the specific resumption rules for 'high-risk' procedures?

Key Response

Laparoscopic cholecystectomy is typically 'low-risk' (24-hour interruption), whereas spinal anesthesia is 'high-risk' due to the catastrophic nature of a spinal hematoma (48-hour interruption). For high-risk procedures, the PAUSE protocol mandates waiting 48-72 hours post-operatively before resuming the full dose of DOAC to ensure primary hemostasis is secure, whereas low-risk procedures can resume the next day.

Fellow
Fellow

The PAUSE study noted a specific exception for Dabigatran in patients with moderate renal impairment (CrCl 30-50 mL/min). Why did this cohort require a 4-day preoperative interruption for high-risk procedures compared to the standard 2-day interruption for Apixaban or Rivaroxaban?

Key Response

Dabigatran is uniquely dependent on renal clearance (~80%) compared to the Factor Xa inhibitors (Apixaban ~27%, Rivaroxaban ~33%). In patients with a CrCl <50 mL/min, the half-life of Dabigatran significantly prolongs, necessitating a longer washout period to ensure residual anticoagulant levels are below the <50 ng/mL safety threshold targeted by the study.

Attending
Attending

The PAUSE study achieved high safety outcomes without routine preoperative laboratory testing of DOAC levels. Does this evidence suggest we should abandon 'bridging' and 'pre-op levels' entirely in the elective setting, or are there specific 'grey-zone' populations where the PAUSE protocol may still be insufficient?

Key Response

While PAUSE provides a robust framework for the 'average' patient, attendings should recognize that it excluded patients with mechanical valves, severe renal failure (CrCl <25-30), and those with high-risk thrombophilia. In patients with extreme BMI or those undergoing neurosurgical procedures where even minimal residual anticoagulation is unacceptable, a pre-operative anti-Xa level or diluted thrombin time may still be a wise adjunct to the PAUSE timing.

Scholarly Review

Critical appraisal through the lens of expert reviewers and guideline development

PhD
PhD

The PAUSE study utilized a prospective management cohort design with a fixed 'safety threshold' for major bleeding and stroke. Critique the statistical implications of using this design rather than a non-inferiority Randomized Controlled Trial (RCT) against 'standard of care' or warfarin-bridging controls.

Key Response

A management cohort allows for higher external validity and the study of a standardized clinical pathway, but it lacks a head-to-head comparison group. By using predefined safety benchmarks (e.g., <1% for stroke), the researchers assume historical data remains a stable comparator. A PhD-level critique would note that 'standard of care' was highly variable at the time, making an RCT difficult to power, but the cohort design cannot account for the 'Hawthorne effect' of protocol adherence within study sites.

Journal Editor
Journal Editor

As a reviewer, the 'residual drug level' substudy in PAUSE is a critical piece of the paper's impact. However, only a subset of patients had these levels measured. How does the discrepancy between the protocol's timing and the actual percentage of patients reaching the <50 ng/mL threshold affect the internal validity of the study's conclusions?

Key Response

Editors look for the 'biological plausibility' of a protocol. In PAUSE, over 90% of patients met the <50 ng/mL target for low-risk and 98-99% for high-risk procedures. A reviewer would flag if a large percentage of patients had high residual levels despite the protocol; the high 'success' rate of the pharmacokinetic target validates that the interruption intervals were appropriately calibrated to the drugs' half-lives.

Guideline Committee
Guideline Committee

The 2017 ACC Expert Consensus and 2018 EHRA guidelines had slight variations in DOAC interruption intervals. Does the PAUSE study provide sufficient Level 1 evidence to unify these guidelines into a single standardized interruption 'clock' for AFib patients, and how does it address the previous ambiguity regarding 'minimal' versus 'low' risk procedures?

Key Response

PAUSE provides some of the highest quality prospective data available (LOE B-R or A). It simplifies the previous 'sliding scales' into a binary risk model (Low vs. High). Current updates to the Chest (ACCP) and AHA/ACC guidelines have heavily integrated the PAUSE findings, moving away from 'minimal risk' distinctions toward a more pragmatic 'no-interruption' vs 'interruption' approach, effectively setting the PAUSE protocol as the new clinical standard for elective DOAC management.

Clinical Landscape

Noteworthy Related Trials

2009

RE-LY Trial

n = 18,113 · NEJM

Tested

Dabigatran (110mg or 150mg BID)

Population

Patients with atrial fibrillation at risk of stroke

Comparator

Warfarin

Endpoint

Stroke or systemic embolism

Key result: Dabigatran 150mg was superior to warfarin in reducing stroke, while 110mg was non-inferior with lower major bleeding rates.
2011

ARISTOTLE Trial

n = 18,201 · NEJM

Tested

Apixaban 5mg BID

Population

Patients with atrial fibrillation

Comparator

Warfarin

Endpoint

Stroke or systemic embolism

Key result: Apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality.
2011

ROCKET AF Trial

n = 14,264 · NEJM

Tested

Rivaroxaban 20mg daily

Population

Patients with nonvalvular atrial fibrillation

Comparator

Warfarin

Endpoint

Stroke or systemic embolism

Key result: Rivaroxaban was non-inferior to warfarin for the prevention of stroke or systemic embolism in patients with atrial fibrillation.

Tailored to your role

Want this tailored to you?

Add your specialty or training stage to get role-specific takeaways and more questions.

Personalize this analysis