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Bleeding complications in patients with coronary stents during non-cardiac surgery
Pierre Albaladejo1, Hélène Charbonneau2, Charles-Marc Samama3
1Department of Anaesthesia and Intensive Care Medicine, Grenoble University Hospital, Grenoble, France; ThEMAS, TIMC, UMR, CNRS 5525, Univ. Grenoble Alpes, France.
Insights
Patients with coronary stents undergoing non-cardiac surgery face a high risk of bleeding complications. Anticoagulant use and procedure type significantly impact postoperative hemorrhage risk.
Area of Science:
- Cardiology
- Vascular Surgery
- Anesthesiology
Background:
- Patients with coronary stents frequently require non-cardiac invasive procedures.
- These procedures carry risks of thrombotic and hemorrhagic complications.
- Factors like procedure type and antiplatelet therapy influence bleeding risk.
Purpose of the Study:
- To analyze postoperative risk factors for hemorrhagic complications in patients with coronary stents.
- To assess the impact of antiplatelet and anticoagulant strategies on bleeding risk during non-cardiac surgery.
Main Methods:
- Prospective, multicentre observational cohort study.
- 1134 consecutive patients with coronary stents undergoing non-cardiac surgery.
- Primary outcome: hemorrhagic complication within 30 days post-surgery.
Main Results:
- 9.5% of patients (108/1134) experienced postoperative hemorrhagic complications.
- Major complications occurred in 85.2%, with 18.5% requiring reoperation.
- Independent risk factors included high/intermediate bleeding risk procedures and anticoagulant use/dosage.
Conclusions:
- Patients with coronary stents undergoing non-cardiac surgery are at significant risk of hemorrhagic complications.
- Anticoagulant therapy and procedure bleeding risk are key factors influencing outcomes.
Introduction:
Patients with coronary stents often undergo non-cardiac invasive procedures. These are often associated with thrombotic and/or hemorrhagic complications. The type of procedure, perioperative antiplatelet therapy, and other patient-related factors influence the risk of postoperative haemorrhage. Our objective was to analyze the postoperative risk factors for hemorrhagic complications and to determine the impact of antiplatelet and anticoagulant therapy strategies on postoperative bleeding risk in patients with coronary stents undergoing non-cardiac surgery.
Patients And Methods:
Prospective, multicentre observational cohort study of 1134 consecutive patients with coronary stents undergoing non-cardiac surgery between April 2007 and April 2009. The primary outcome measure was the occurrence of an hemorrhagic complication during the first 30days following the surgery or intervention.
Results:
Among the 1134 patients evaluated, 108 (9.5%) experienced a postoperative hemorrhagic complication (with a median time to occurrence of 5.3days). These complications were considered major, involved the operative site, and required reoperation in 92 (85.2%), 92 (85.2%), and 20 (18.5%) of patients, respectively. Mortality in patients with a haemorrhagic complication was 12% (n=13). Independent postoperative factors associated with haemorrhagic complications were identified as a high and intermediate bleeding risk procedure and the use and dose of anticoagulants. When interrupted before the procedure, resumption of antiplatelet treatment was delayed in patients developing early postoperative hemorrhagic complications.
Conclusion:
Patients with coronary stents who undergo surgery are at high risk for hemorrhagic complications.
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