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Perioperative risk and antiplatelet management in patients undergoing non-cardiac surgery within 1 year of PCI
- Source :
- Journal of Thrombosis and Thrombolysis. 53:380-389
- Publication Year :
- 2021
- Publisher :
- Springer Science and Business Media LLC, 2021.
-
Abstract
- Perioperative cardiovascular complications are important causes of morbidity and mortality associated with non-cardiac surgery, especially in patients with recent percutaneous coronary intervention (PCI). We aimed to illustrate the types and timing of different surgeries occurring after PCI, and to evaluate the risk of thrombotic and bleeding events according to the perioperative antiplatelet management. Patients undergoing urgent or elective non-cardiac surgery within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, or stent thrombosis) at 30 days. Perioperative bleeding was defined as ≥ 2 units of blood transfusion. A total of 1092 surgeries corresponding to 747 patients were classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones, and were associated with an increased risk of both MACE and bleeding. Preoperative interruption of antiplatelet therapy (of any kind) occurred in 44.6% of all NCS and was more likely for procedures occurring later post-PCI and at intermediate risk. There was no significant association between interruption of antiplatelet therapy and adverse cardiac events. Among patients undergoing NCS within 1 year of PCI, perioperative ischemic and bleeding events primarily depend on the estimated surgical risk and urgency of the procedure, which are increased early after PCI. Preoperative antiplatelet interruption was not associated with an increased risk of cardiac events.
- Subjects :
- medicine.medical_specialty
Hematology
Blood transfusion
business.industry
medicine.medical_treatment
Percutaneous coronary intervention
Perioperative
medicine.disease
Surgery
Internal medicine
Conventional PCI
Medicine
In patient
cardiovascular diseases
Myocardial infarction
Cardiology and Cardiovascular Medicine
business
Mace
Subjects
Details
- ISSN :
- 1573742X and 09295305
- Volume :
- 53
- Database :
- OpenAIRE
- Journal :
- Journal of Thrombosis and Thrombolysis
- Accession number :
- edsair.doi...........11d6ceafbcbcef676a7977ac40d7681b