Key result
In patients undergoing moderate to high risk surgery, concordance with perioperative antithrombotic guidelines was low, bridging therapy was prevalent, and co-morbid renal disease independently predicted major bleeding (aOR 2.65).
Observational (n=329)
No
Odds Ratio: 2.65 (95% CI 1.33–5.28)
Concordance with ACCP guidelines for perioperative antithrombotic management was low in real-world practice, with frequent overuse of bridging therapy and a high rate of major bleeding, particularly in patients with comorbid renal disease.
Objective: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between the risk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in real world setting. Methods: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010 to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzed the timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate of thromboembolic event and major hemorrhage were also investigated. Results: A total of 329 patients were included. The concordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patients undergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2% and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant before surgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleeding and thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for major bleeding (adjusted OR 2.65. 95% CI 1.33-5.28). Conclusion: The concordance rate with guideline regarding perioperative antithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.
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Lee et al. (2017) conducted an observational in Patients taking antithrombotics undergoing moderate to high risk surgery (n=329). Perioperative antithrombotic management was evaluated on Major bleeding after surgery (predicted by co-morbid renal disease) (adjusted OR 2.65, 95% CI 1.33-5.28). In patients undergoing moderate to high risk surgery, concordance with perioperative antithrombotic guidelines was low, bridging therapy was prevalent, and co-morbid renal disease independently predicted major bleeding (aOR 2.65).
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