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Perioperative cardiovascular complications versus perioperative bleeding in consecutive patients with known cardiac disease undergoing non-cardiac surgery. Focus on antithrombotic medication. The PRAGUE-14 registry
- Source :
- Netherlands Heart Journal
- Publication Year :
- 2014
-
Abstract
- Background Interruption of antithrombotic treatment before surgery may prevent bleeding, but at the price of increasing cardiovascular complications. This prospective study analysed the impact of antithrombotic therapy interruption on outcomes in non-selected surgical patients with known cardiovascular disease (CVD). Methods All 1200 consecutive patients (age 74.2 ± 10.2 years) undergoing major non-cardiac surgery (37.4 % acute, 61.4 % elective) during a period of 2.5 years while having at least one CVD were enrolled. Details on medication, bleeding, cardiovascular complications and cause of death were registered. Results In-hospital mortality was 3.9 % (versus 0.9 % mortality among 17,740 patients without CVD). Cardiovascular complications occurred in 91 (7.6 %) patients (with 37.4 % case fatality). Perioperative bleeding occurred in 160 (13.3 %) patients and was fatal in 2 (1.2 % case fatality). Multivariate analysis revealed age, preoperative anaemia, history of chronic heart failure, acute surgery and general anaesthesia predictive of cardiovascular complications. For bleeding complications multivariate analysis found warfarin use in the last 3 days, history of hypertension and general anaesthesia as independent predictive factors. Aspirin interruption before surgery was not predictive for either cardiovascular or for bleeding complications. Conclusions Perioperative cardiovascular complications in these high-risk elderly all-comer surgical patients with known cardiovascular disease are relatively rare, but once they occur, the case fatality is high. Perioperative bleeding complications are more frequent, but their case fatality is extremely low. Patterns of interruption of chronic aspirin therapy before major non-cardiac surgery are not predictive for perioperative complications (neither cardiovascular, nor bleeding). Simple baseline clinical factors are better predictors of outcomes than antithrombotic drug interruption patterns.
- Subjects :
- medicine.medical_specialty
Thienopyridines
Disease
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Non-cardiac surgery
Antithrombotic
medicine
030212 general & internal medicine
Prospective cohort study
Antithrombotic therapy
Aspirin
business.industry
Perioperative bleeding
Warfarin
Thrombosis
Perioperative
medicine.disease
3. Good health
Surgery
Non cardiac surgery
Perioperative ischemia
Original Article
business
Cardiology and Cardiovascular Medicine
medicine.drug
Subjects
Details
- ISSN :
- 15685888
- Volume :
- 22
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
- Accession number :
- edsair.doi.dedup.....a6afd33ec5010f10a4d23a5f3a4e66d8