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Impact of perioperative antithrombotic strategies on clinical events in non-cardiac surgery

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Abstract

Antithrombotic therapy including antiplatelet agents and anticoagulants are prescribed for secondary prevention in patients with established cardiovascular disease. Although antithrombotic therapy is often interrupted before non-cardiac surgery with or without perioperative bridging anticoagulation, the impact on thrombotic and bleeding events remains uncertain. A total of 360 patients chronically treated with antithrombotic therapy for secondary prevention underwent elective non-cardiac surgery under general anesthesia, with the complete interruption of antithrombotic agents. The study endpoints included all-cause death, thrombotic events, and major bleeding complications after surgical procedures. Of 360 patients, 190 (52.8%) and 200 (55.6%) received antiplatelet and anticoagulation perioperatively. Atrial fibrillation (32.8%) and coronary artery disease (22.5%) were the major indications for antithrombotic regimens. Antithrombotic therapy was interrupted from 5 [2, 7] days before the surgery to 4 [2, 7] days postoperatively. Perioperative bridging therapy with unfractionated heparin was employed in 113 (31.4%) patients. During the hospitalization, one (0.3%) patient died due to non-cardiovascular causes. Thrombotic events and major bleeding occurred in two (0.6%) and eight (2.2%) patients. Bridging therapy with heparin was significantly associated with an increased risk of bleeding events (5.3% vs. 0.8%, p = 0.02). Pre-operative bridging therapy with heparin and operative duration were significantly associated with bleeding complications. In the present study, complete interruption of antithrombotic therapy resulted in a few thrombotic events in patients undergoing elective non-cardiac surgery. Bridging therapy with heparin and longer operative duration were significantly associated with post-operative bleeding complications.

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Acknowledgements

We would like to express our gratitude for the work of past and present members of our laboratory.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan

    Kan Saito, Yuichi Saito, Hideki Kitahara, Yoshihide Fujimoto & Yoshio Kobayashi

  2. Department of Anesthesiology, Chiba University Graduate School of Medicine, Chiba, Japan

    Takahiro Muramatsu & Shiroh Isono

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  1. Kan Saito
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Correspondence to Kan Saito.

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Saito, K., Saito, Y., Muramatsu, T. et al. Impact of perioperative antithrombotic strategies on clinical events in non-cardiac surgery. Heart Vessels 37, 1337–1343 (2022). https://doi.org/10.1007/s00380-022-02044-9

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