중등도 이상의 위험 수술을 받은 환자에서 수술 전후 항혈전제 약물 사용 평가
Evaluation of Perioperative Antithrombotic Management in Patients Undergoing Moderate to High Risk Surgery
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Objective: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between therisk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in realworld setting. Methods: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzedthe timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate ofthromboembolic event and major hemorrhage were also investigated. Results: A total of 329 patients were included. Theconcordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patientsundergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2%and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant beforesurgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleedingand thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for majorbleeding (adjusted OR 2.65. 95% CI 1.33-5.28). Conclusion: The concordance rate with guideline regarding perioperativeantithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.
Abstract
Objective: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between therisk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in realworld setting. Methods: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzedthe timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate ofthromboembolic event and major hemorrhage were also investigated. Results: A total of 329 patients were included. Theconcordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patientsundergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2%and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant beforesurgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleedingand thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for majorbleeding (adjusted OR 2.65. 95% CI 1.33-5.28). Conclusion: The concordance rate with guideline regarding perioperativeantithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.
참고문헌 (14)
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