The impact of preoperative maintaining antithrombotic therapy in patients undergoing non-coronary endovascular interventions

BACKGROUND: Antithrombotic medications, including antiplatelet and anticoagulant therapies, are widely used to prevent thromboembolic events in patients with cardiovascular diseases. It is common for patients on antithrombotic medications to undergo endovascular interventions though potential complications remain unclear. This study investigated the impact of continuing antithrombotic medications before endovascular interventions on perioperative clinical outcomes, particularly intraoperative blood transfusion. METHODS: This retrospective cohort study included patients who underwent endovascular interventions between January 2019 and December 2022. Patients were divided into four groups based on the preoperative antithrombotic medications: (1) those not receiving any antithrombotic therapy; (2) those receiving single antiplatelet therapy; (3) those receiving dual antiplatelet therapy; (4) those receiving anticoagulant therapy. Clinical outcomes, including blood transfusion, hematoma and pseudoaneurysm, were analyzed using multivariate logistics regression. Subsequently, patients were stratified based on whether they received blood transfusion. All-cause mortality, adverse cardiovascular events and infectious events were used to evaluate the impact of blood transfusion. RESULTS: A total of 5743 patients were included, with a mean age of 67.08 ± 14.27 years, and 69.81% of them were male. Common underlying conditions included hypertension (60.48%), vascular disease (28.75%), diabetes mellitus (22.60%), congestive heart failure (6.39%), and immune disease (4.21%). Compared to patients not receiving any antithrombotic medications, those undergoing dual antiplatelet therapy or anticoagulant therapy exhibited an increased risk of requiring blood transfusion (OR: 2.05, 95%CI: 1.30-3.23; OR: 1.92, 95%CI: 1.22-3.03). Subgroup analysis indicated that the risk of blood transfusion varied depending on the type of anesthesia, number of puncture sites and renal function, with a significant interaction (P < 0.05). Patients who required blood transfusion had a significantly higher rate of one-year all-cause mortality (HR: 2.18, 95% CI: 1.10-4.32) and three-month infectious events (HR: 4.92, 95% CI: 1.72-14.06). CONCLUSIONS: Preoperative maintaining dual antiplatelet or anticoagulant therapy increased the risk of blood transfusion in endovascular interventions. Blood transfusion was independently associated with increased risk of all-cause mortality and infectious events. These findings suggested the need for tailored perioperative management of antithrombotic therapy in patients undergoing endovascular interventions.