PRAGUE 14: Antithrombotic Therapy Before Surgery Associated With Higher Bleeding Complications

"There's always the bias that the patients who are at highest risk for bleeding, or highest risk for spontaneous thrombosis, will have their medications adjusted because of that," said Tony DeMaria, MD, MACC.
Antithrombotic therapy before major non-cardiac surgery was not found to be associated with a lower risk of perioperative cardiovascular complications, and was associated with an increased risk of bleeding, according to results presented Sept. 1 at the ESC Congress 2013 in Amsterdam.

The prospective study looked at 1,211 patients undergoing acute and elective major non-cardiac surgery over 2.5 years with at least one known cardiac disease. Results showed that cardiovascular complications occurred in 91 patients, and bleeding occurred in 159 patients. Further, in-hospital mortality was 3.9 percent.

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The investigators note that patients with no or short aspirin interruption before surgery had more bleeding complications and cardiovascular complications than those whom aspirin was stopped at least one week before surgery. "However, multivariate statistical analysis didn't find this to be an independent factor," the investigators explain. They speculate that it might have been "related to the fact that short [aspirin] interruption was mostly among patients undergoing acute surgery (with inherent higher risk)."

The investigators conclude that antithrombotic therapy interruption shortly before surgery was not associated with lower risk of perioperative cardiovascular complications in the overall population, but among elective surgical patients, "there was a trend towards increased risk of complications when [aspirin] was stopped four to eight days prior to surgery." Moving forward, "a more detailed analysis on the subgroup of elective surgical patients is planned," they add.

Keywords: Heart Diseases, Risk, Multivariate Analysis, Hospital Mortality, Thrombosis, Cardiac Surgical Procedures, Hemorrhage

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