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Published on: March 15, 2022
The impact of preoperative maintaining antithrombotic therapy in patients undergoing non-coronary endovascular
Jiaqi Li1, Linlin Fu2, Yepeng Zhang1
1Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu, China.
Insights
Continuing dual antiplatelet or anticoagulant therapy before endovascular interventions increases blood transfusion risk. Blood transfusion independently raises mortality and infection risks, necessitating personalized antithrombotic management.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Antithrombotic medications are crucial for preventing thromboembolic events in cardiovascular disease patients.
- Endovascular interventions are common, but the implications of continuing antithrombotic therapy perioperatively are not fully understood.
- This study examines the impact of preoperative antithrombotic use on clinical outcomes, focusing on blood transfusions during endovascular procedures.
Purpose of the Study:
- To investigate the association between continuing antithrombotic medications (antiplatelet and anticoagulant therapies) and perioperative outcomes in patients undergoing endovascular interventions.
- To specifically assess the impact on intraoperative blood transfusion requirements.
- To evaluate the subsequent clinical consequences of blood transfusion in this patient cohort.
Main Methods:
- A retrospective cohort study of 5743 patients undergoing endovascular interventions from January 2019 to December 2022.
- Patients were categorized into four groups based on preoperative antithrombotic medication use: none, single antiplatelet, dual antiplatelet, or anticoagulant therapy.
- Multivariate logistic regression analyzed outcomes including blood transfusion, hematoma, and pseudoaneurysm; further analysis stratified by transfusion status to assess mortality and adverse events.
Main Results:
- Patients on dual antiplatelet therapy or anticoagulant therapy showed a significantly increased risk of blood transfusion compared to those on no antithrombotics (OR 2.05 and 1.92, respectively).
- The risk of blood transfusion was influenced by anesthesia type, number of puncture sites, and renal function.
- Blood transfusion was independently linked to higher one-year all-cause mortality (HR 2.18) and three-month infectious events (HR 4.92).
Conclusions:
- Continuing dual antiplatelet or anticoagulant therapy pre-endovascular intervention elevates the likelihood of requiring blood transfusion.
- Blood transfusion post-intervention is an independent predictor of increased all-cause mortality and infectious complications.
- Tailored perioperative management strategies for antithrombotic therapy are essential for patients undergoing endovascular procedures.
Background:
Antithrombotic medications, including antiplatelet and anticoagulant therapies, are widely used to prevent thromboembolic events in patients with cardiovascular diseases. It is common for patients on antithrombotic medications to undergo endovascular interventions though potential complications remain unclear. This study investigated the impact of continuing antithrombotic medications before endovascular interventions on perioperative clinical outcomes, particularly intraoperative blood transfusion.
Methods:
This retrospective cohort study included patients who underwent endovascular interventions between January 2019 and December 2022. Patients were divided into four groups based on the preoperative antithrombotic medications: (1) those not receiving any antithrombotic therapy; (2) those receiving single antiplatelet therapy; (3) those receiving dual antiplatelet therapy; (4) those receiving anticoagulant therapy. Clinical outcomes, including blood transfusion, hematoma and pseudoaneurysm, were analyzed using multivariate logistics regression. Subsequently, patients were stratified based on whether they received blood transfusion. All-cause mortality, adverse cardiovascular events and infectious events were used to evaluate the impact of blood transfusion.
Results:
A total of 5743 patients were included, with a mean age of 67.08 ± 14.27 years, and 69.81% of them were male. Common underlying conditions included hypertension (60.48%), vascular disease (28.75%), diabetes mellitus (22.60%), congestive heart failure (6.39%), and immune disease (4.21%). Compared to patients not receiving any antithrombotic medications, those undergoing dual antiplatelet therapy or anticoagulant therapy exhibited an increased risk of requiring blood transfusion (OR: 2.05, 95%CI: 1.30-3.23; OR: 1.92, 95%CI: 1.22-3.03). Subgroup analysis indicated that the risk of blood transfusion varied depending on the type of anesthesia, number of puncture sites and renal function, with a significant interaction (P < 0.05). Patients who required blood transfusion had a significantly higher rate of one-year all-cause mortality (HR: 2.18, 95% CI: 1.10-4.32) and three-month infectious events (HR: 4.92, 95% CI: 1.72-14.06).
Conclusions:
Preoperative maintaining dual antiplatelet or anticoagulant therapy increased the risk of blood transfusion in endovascular interventions. Blood transfusion was independently associated with increased risk of all-cause mortality and infectious events. These findings suggested the need for tailored perioperative management of antithrombotic therapy in patients undergoing endovascular interventions.
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