Direct Oral Anticoagulants Are Associated With Less Bleeding Risk Than Warfarin in Patients Undergoing Liver Resections

Article: Direct Oral Anticoagulants Are Associated With Less Bleeding Risk Than Warfarin in Patients Undergoing Liver Resections

Authors: Abdullah Sohail, Mary T. Powers, Tricia Suarez, Kathryn Wittrock, Faisal S. Jehan, Yong K. Kwon, Hassan Aziz

Journal: J Surg Res. 2026;321:383-388

Abstract:
Introduction: The safety profile of direct oral anticoagulants (DOACs) compared to warfarin in patients undergoing liver resections remains an area of active research.

Methods: We performed a retrospective analysis of the TriNetX database. Patients were categorized into two groups based on the anticoagulant they were on before surgery: DOACs or warfarin. The primary outcome measure was postoperative hemorrhage.

Results: After propensity score matching, there were 1301 patients in each group. Patients taking preoperative DOACs were less likely to have intraoperative hemorrhage (0.76% versus 2.1%; P < 0.01). There was no difference in the need for postoperative angioembolization between the two groups (0.76% versus 0.75%; P = 1) or 30-d mortality (0.92% versus 1.7%; P = 0.06). A higher incidence of postoperative deep vein thrombosis/pulmonary embolism was observed in the warfarin group (16.4% versus 20.5%, P < 0.01).

Conclusions: This study suggests that DOACs demonstrate an improved safety profile compared to warfarin in patients undergoing liver resections. While further investigation is needed to uncover the underlying mechanism of these findings, the current trend in prescribing DOACs over warfarin is supported by the increase in positive outcomes, as seen in these results.

Link to journal online: https://www.sciencedirect.com/science/article/pii/S0022480426001290