Exploring factors associated with bleeding events after open heart surgery in patients on dialysis - effects of the presence or absence of warfarin therapy.
Dialysis
Perioperative management
Valve replacement
Valvuloplasty
Warfarin therapy
Journal
Journal of pharmaceutical health care and sciences
ISSN: 2055-0294
Titre abrégé: J Pharm Health Care Sci
Pays: England
ID NLM: 101672177
Informations de publication
Date de publication:
12 Jul 2024
12 Jul 2024
Historique:
received:
15
12
2023
accepted:
11
06
2024
medline:
13
7
2024
pubmed:
13
7
2024
entrez:
12
7
2024
Statut:
epublish
Résumé
Perioperative management of patients on dialysis is critical for controlling bleeding and thrombotic risk, in addition to infection control. Postoperative anticoagulation is often difficult to control, and different institutions have different policies. Therefore, in this study, we aimed to investigate factors associated with postoperative bleeding events and whether warfarin (WF) therapy affects the incidence of postoperative bleeding events, total mortality, and stroke. Patients who were admitted to the cardiovascular surgery department and underwent valve replacement or plasty were included, and those who underwent mechanical valve introduction were excluded. Thirty-nine patients were included in the study. The primary endpoint was to identify factors associated with the composite endpoint of postoperative bleeding events, and the secondary endpoint was to determine the effect size of WF therapy on postoperative bleeding events, all-cause mortality, and stroke and the strength of association between the crossed endpoints. The strength of the association between the crossed items was examined. Low body weight (p = 0.038) was identified as a factor associated with the primary endpoint of postoperative bleeding events. The secondary endpoint of whether or not patients received WF therapy was largely unrelated to bleeding events, all-cause mortality, and postoperative stroke up to 90 days after surgery. Preliminary studies suggest that low body weight is a risk factor for postoperative bleeding events in patients on dialysis, although further exploration of other factors will be necessary with the accumulation of similar cases.
Sections du résumé
BACKGROUND
BACKGROUND
Perioperative management of patients on dialysis is critical for controlling bleeding and thrombotic risk, in addition to infection control. Postoperative anticoagulation is often difficult to control, and different institutions have different policies. Therefore, in this study, we aimed to investigate factors associated with postoperative bleeding events and whether warfarin (WF) therapy affects the incidence of postoperative bleeding events, total mortality, and stroke.
METHODS
METHODS
Patients who were admitted to the cardiovascular surgery department and underwent valve replacement or plasty were included, and those who underwent mechanical valve introduction were excluded. Thirty-nine patients were included in the study. The primary endpoint was to identify factors associated with the composite endpoint of postoperative bleeding events, and the secondary endpoint was to determine the effect size of WF therapy on postoperative bleeding events, all-cause mortality, and stroke and the strength of association between the crossed endpoints. The strength of the association between the crossed items was examined.
RESULTS
RESULTS
Low body weight (p = 0.038) was identified as a factor associated with the primary endpoint of postoperative bleeding events. The secondary endpoint of whether or not patients received WF therapy was largely unrelated to bleeding events, all-cause mortality, and postoperative stroke up to 90 days after surgery.
CONCLUSIONS
CONCLUSIONS
Preliminary studies suggest that low body weight is a risk factor for postoperative bleeding events in patients on dialysis, although further exploration of other factors will be necessary with the accumulation of similar cases.
Identifiants
pubmed: 38997775
doi: 10.1186/s40780-024-00353-x
pii: 10.1186/s40780-024-00353-x
doi:
Types de publication
Journal Article
Langues
eng
Pagination
38Informations de copyright
© 2024. The Author(s).
Références
Nitta K, Masakane I, Hanafusa N, Taniguchi M, Hasegawa T, Nakai S, et al. 2017 Annual dialysis data report, JSDT Renal Data Registry. J Jpn Soc Dial Ther. 2018;51:699–766.
doi: 10.4009/jsdt.51.699
Tanaka S, Ninomiya T, Taniguchi M, Fujisaki K, Tokumoto M, Hirakata H, et al. Comparison of oral versus intravenous vitamin D receptor activator in reducing infection-related mortality in hemodialysis patients: the Q–Cohort study. Nephrol Dial Transpl. 2016;31:1152–60.
doi: 10.1093/ndt/gfw205
Yotsueda R, Taniguchi M, Tanaka S, Eriguchi M, Fujisaki K, Torisu K, et al. Cardiothoracic ratio and all-cause mortality and cardiovascular disease events in hemodialysis patients: the Q–Cohort study. Am J Kidney Dis. 2017;70:84–92.
doi: 10.1053/j.ajkd.2016.11.026
pubmed: 28196648
Fujii H, Kono K, Nakai K, Goto S, Nishii T, Kono A, et al. Effects of Lanthanum carbonate on coronary artery calcification and cardiac abnormalities after initiating hemodialysis. Calcif Tissue Int. 2018;102:310–20.
doi: 10.1007/s00223-017-0347-3
pubmed: 29058057
London GM, Pannier B, Marchais SJ, Guerin AP. Calcification of the aortic valve in the dialyzed patient. J Am Soc Nephrol. 2000;11:778–83.
doi: 10.1681/ASN.V114778
pubmed: 10752538
Kitamura K, Fujii H, Nakai K, Kono K, Goto S, Nishii T, et al. Relationship between cardiac calcification and left ventricular hypertrophy in patients with chronic kidney disease at hemodialysis initiation. Heart Vessels. 2017;32:1109–16.
doi: 10.1007/s00380-017-0969-4
pubmed: 28324126
Teraoka S, Naganuma S, Sasaki Y, Kato M, Kubo K, Kaneko I, et al. Perioperative management of patients with end-stage renal failure undergoing cardiac surgery. J Jpn Soc Dial Ther. 1988;21:545–9. (in Japanese).
doi: 10.4009/jsdt1985.21.545
Hirakata H, Nitta K, Tomo T, Akiba T, Ikari Y, Iseki K, et al. Clinical guidelines for the evaluation and the treatment of cardiovascular complications in hemodialysis patients. J Jpn Soc Dial Ther. 2011;44:337–8. (in Japanese).
doi: 10.4009/jsdt.44.1129
Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg. 1993;56:539–49.
doi: 10.1016/0003-4975(93)90894-N
pubmed: 8379728
Fuller JA, Adams GG, Buxton B. Atrial fibrillation after coronary artery bypass grafting. Is it a disorder of the elderly? J Thorac Cardiovasc Surg. 1989;97:821–5.
doi: 10.1016/S0022-5223(19)34483-6
pubmed: 2566713
Ishii Y, Gleva MJ, Gamache MC, Schuessler RB, Boineau JP, Bailey MS, et al. Atrial tachyarrhythmias after the maze procedure: incidence and prognosis. Circulation. 2004;110:–164.
Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, et al. JCS/JSCS/JATS/JSVS 2020 guidelines on the management of valvular heart disease. Circ J. 2020;84:2037–119.
doi: 10.1253/circj.CJ-20-0135
pubmed: 32921646
Nakamura M, Iizuka T, Sagawa K, Abe K, Chikada S, Arai M. Prasugrel for Japanese patients with acute coronary syndrome in short-term clinical practice (PRASFIT-Practice I): a post-marketing observational study. Cardiovasc Interv Ther. 2018;33:135–45.
doi: 10.1007/s12928-017-0459-8
pubmed: 28213685
Numasawa Y, Kohsaka S, Ueda I, Miyata H, Sawano M, Kawamura A, et al. Incidence and predictors of bleeding complications after percutaneous coronary intervention. J Cardiol. 2017;69:272–9.
doi: 10.1016/j.jjcc.2016.05.003
pubmed: 27269413
Nakamura M, Kitazono T, Kozuma K, Sekine T, Nakamura S, Shiosakai K, et al. Prasugrel for Japanese patients with ischemic heart disease in long-term clinical practice (PRASFIT-Practice II) – 1-year follow-up results of a post-marketing observational study. Circ J. 2020;84:101–8.
doi: 10.1253/circj.CJ-19-0645
Lei H, Yu LT, Wang WN, Zhang SG. Warfarin and the risk of death, stroke, and major bleeding in patients with atrial fibrillation receiving hemodialysis: a systematic review and meta-analysis. Front Pharmacol. 2018;9:1218.
doi: 10.3389/fphar.2018.01218
pubmed: 30459610
pmcid: 6232383
Howitt D, Cramer D. An introduction to statistics in psychology. rev. 2nd ed. Harlow: Prentice Hall; 2003.
Wedel M, Kamakula WA. Market segmentation: conceptual and methodological foundations. 2nd ed. Norwell: Kluwer Academic; 2000.
doi: 10.1007/978-1-4615-4651-1
Nakamura M, Kimura K, Kimura T, Ishihara M, Otsuka F, Kozuma K, et al. JCS 2020 guideline focused update on antithrombotic therapy in patients with coronary artery disease. Circ J. 2020;84:831–65.
doi: 10.1253/circj.CJ-19-1109
pubmed: 32173684
Kojima G, Iliffe S, Taniguchi Y, Shimada H, Rakugi H, Walters K. Prevalence of frailty in Japan: a systematic review and meta-analysis. J Epidemiol. 2017;27:347–53.
doi: 10.1016/j.je.2016.09.008
pubmed: 28142044
Joosten LPT, van Doorn S, van de Ven PM, Köhlen BTG, Nierman MC, Koek HL, et al. Safety of switching from a vitamin K antagonist to a non-vitamin K antagonist oral anticoagulant in frail older patients with atrial fibrillation: results of the FRAIL-AF randomized controlled trial. Circulation. 2024;149:279–89.
pubmed: 37634130
Rahmanian PB, Adams DH, Castillo JG, Vassalotti J, Filsoufi F. Early and late outcome of cardiac surgery in dialysis-dependent patients: single-center experience with 245 consecutive patients. J Thorac Cardiovasc Surg. 2008;135:915–22.
doi: 10.1016/j.jtcvs.2007.09.027
pubmed: 18374780
Stirnadel-Farrant HA, Karaboyas A, Cizman B, Bieber BA, Kler L, Jones D, et al. Cardiovascular event rates among hemodialysis patients across geographical regions-a snapshot from the dialysis outcomes and practice patterns study (DOPPS). Kidney Int Rep. 2019;4:864–72.
doi: 10.1016/j.ekir.2019.03.016
pubmed: 31194073
pmcid: 6551512