Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery.
Adult
Aged
Aged, 80 and over
Cohort Studies
Coronary Vessels
Drug Therapy, Combination
Female
Hemorrhage
/ chemically induced
Humans
Male
Middle Aged
Perioperative Care
Platelet Aggregation Inhibitors
/ adverse effects
Propensity Score
Prospective Studies
Risk
Stents
Surgical Procedures, Operative
/ methods
Thrombosis
/ chemically induced
acetylsalicylic acid
antiplatelet therapy
bleeding
major adverse cardiovascular events
outcome
percutaneous coronary intervention
surgery
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
02
08
2017
revised:
16
09
2018
accepted:
24
09
2018
entrez:
29
1
2019
pubmed:
29
1
2019
medline:
4
4
2019
Statut:
ppublish
Résumé
The perioperative management of antiplatelet therapy in noncardiac surgery patients who have undergone previous percutaneous coronary intervention (PCI) remains a dilemma. Continuing dual antiplatelet therapy (DAPT) may carry a risk of bleeding, while stopping antiplatelet therapy may increase the risk of perioperative major adverse cardiovascular events (MACE). Occurrence of Bleeding and Thrombosis during Antiplatelet Therapy In Non-Cardiac Surgery (OBTAIN) was an international prospective multicentre cohort study of perioperative antiplatelet treatment, MACE, and serious bleeding in noncardiac surgery. The incidences of MACE and bleeding were compared in patients receiving DAPT, monotherapy, and no antiplatelet therapy before surgery. Unadjusted risk ratios were calculated taking monotherapy as the baseline. The adjusted risks of bleeding and MACE were compared in patients receiving monotherapy and DAPT using propensity score matching. A total of 917 patients were recruited and 847 were eligible for inclusion. Ninety-six patients received no antiplatelet therapy, 526 received monotherapy with aspirin, and 225 received DAPT. Thirty-two patients suffered MACE and 22 had bleeding. The unadjusted risk ratio for MACE in patients receiving DAPT compared with monotherapy was 1.9 (0.93-3.88), P=0.08. There was no difference in MACE between no antiplatelet treatment and monotherapy 1.03 (0.31-3.46), P=0.96. Bleeding was more frequent with DAPT 6.55 (2.3-17.96) P=0.0002. In a propensity matched analysis of 177 patients who received DAPT and 177 monotherapy patients, the risk ratio for MACE with DAPT was 1.83 (0.69-4.85), P=0.32. The risk of bleeding was significantly greater in the DAPT group 4.00 (1.15-13.93), P=0.031. OBTAIN showed an increased risk of bleeding with DAPT and found no evidence for protective effects of DAPT from perioperative MACE in patients who have undergone previous PCI.
Sections du résumé
BACKGROUND
BACKGROUND
The perioperative management of antiplatelet therapy in noncardiac surgery patients who have undergone previous percutaneous coronary intervention (PCI) remains a dilemma. Continuing dual antiplatelet therapy (DAPT) may carry a risk of bleeding, while stopping antiplatelet therapy may increase the risk of perioperative major adverse cardiovascular events (MACE).
METHODS
METHODS
Occurrence of Bleeding and Thrombosis during Antiplatelet Therapy In Non-Cardiac Surgery (OBTAIN) was an international prospective multicentre cohort study of perioperative antiplatelet treatment, MACE, and serious bleeding in noncardiac surgery. The incidences of MACE and bleeding were compared in patients receiving DAPT, monotherapy, and no antiplatelet therapy before surgery. Unadjusted risk ratios were calculated taking monotherapy as the baseline. The adjusted risks of bleeding and MACE were compared in patients receiving monotherapy and DAPT using propensity score matching.
RESULTS
RESULTS
A total of 917 patients were recruited and 847 were eligible for inclusion. Ninety-six patients received no antiplatelet therapy, 526 received monotherapy with aspirin, and 225 received DAPT. Thirty-two patients suffered MACE and 22 had bleeding. The unadjusted risk ratio for MACE in patients receiving DAPT compared with monotherapy was 1.9 (0.93-3.88), P=0.08. There was no difference in MACE between no antiplatelet treatment and monotherapy 1.03 (0.31-3.46), P=0.96. Bleeding was more frequent with DAPT 6.55 (2.3-17.96) P=0.0002. In a propensity matched analysis of 177 patients who received DAPT and 177 monotherapy patients, the risk ratio for MACE with DAPT was 1.83 (0.69-4.85), P=0.32. The risk of bleeding was significantly greater in the DAPT group 4.00 (1.15-13.93), P=0.031.
CONCLUSIONS
CONCLUSIONS
OBTAIN showed an increased risk of bleeding with DAPT and found no evidence for protective effects of DAPT from perioperative MACE in patients who have undergone previous PCI.
Identifiants
pubmed: 30686302
pii: S0007-0912(18)30809-2
doi: 10.1016/j.bja.2018.09.029
pii:
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
170-179Investigateurs
B Leva
(B)
B Plichon
(B)
S Damster
(S)
M Momeni
(M)
C Watremez
(C)
D Kahn
(D)
A-S Dincq
(AS)
A Danila
(A)
M Wittmann
(M)
R Struck
(R)
T Rüddel
(T)
F Kessler
(F)
S Rasche
(S)
P Matsota
(P)
A Hasani
(A)
J Gudaityte
(J)
A Karbonskiene
(A)
R Ferreira
(R)
S Carvalho
(S)
D Tomescu
(D)
C Martac
(C)
I Grintescu
(I)
L Mirea
(L)
L Serrano
(L)
L Serrano
(L)
P Sierra
(P)
S Sabaté
(S)
D Hernando
(D)
P Matute
(P)
M Trashorras
(M)
M Suñé
(M)
L Sarmiento
(L)
A Hervias
(A)
O González
(O)
A Hermina
(A)
O González
(O)
A Hermina
(A)
R Navarro Perez
(R)
M Orts
(M)
R Fernandez-Garcia
(R)
D Sanchez Pérez
(D)
I Sepulveda Gil
(I)
P Monedero
(P)
F Hidalgo
(F)
C Mbongo
(C)
A R Pont
(AR)
H M Reyes
(HM)
C G Bartolo
(CG)
S L Galera
(SL)
T Valentijn
(T)
R J Stolker
(RJ)
M Tugrul
(M)
E Emre Demirel
(E)
M Hough
(M)
K Griffiths
(K)
S Birch
(S)
Z Beardow
(Z)
S Elliot
(S)
J Thompson
(J)
S Bowrey
(S)
M Northey
(M)
H Melson
(H)
R Telford
(R)
M Nadolski
(M)
A Potter
(A)
D Fuller
(D)
A Rose
(A)
S Varma
(S)
K Simeson
(K)
J Pettit
(J)
N Smith
(N)
V Martinson
(V)
L Sleight
(L)
C Naylor
(C)
P Watt
(P)
P Raymode
(P)
N Dunk
(N)
L Twohey
(L)
L Hollos
(L)
S Davies
(S)
A Gibson
(A)
Z Coleman
(Z)
T Tamm
(T)
J Joscak
(J)
L Zsisku
(L)
M Zuleika
(M)
P Carvalho
(P)
T Collyer
(T)
J Ryan
(J)
K Colling
(K)
S Dharmarajah
(S)
A Krishnan
(A)
J Paddle
(J)
A Fouracres
(A)
K Arnell
(K)
K Muhammad
(K)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.