Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery

被引：28

作者：

Howell, S. J. ^{[1
]}

Hoeks, S. E. ^{[2
]}

West, R. M. ^{[3
]}

Wheatcroft, S. B. ^{[4
]}

Hoeft, A. ^{[5
]}

Leva, Brigitte

Plichon, Benoit

Damster, Sandrine

Momeni, Mona ^{[6
]}

Watremez, Christine ^{[6
]}

Kahn, David ^{[6
]}

Dincq, Anne-Sophie ^{[7
]}

Danila, Andre ^{[8
]}

Wittmann, Maria ^{[9
]}

Struck, Rafael ^{[9
]}

Rueddel, Torben ^{[9
]}

Kessler, Florian ^{[9
]}

Rasche, Stefan ^{[10
]}

Matsota, Paraskevi ^{[11
]}

Hasani, Antigona ^{[12
]}

Gudaityte, Jurate ^{[13
]}

Karbonskiene, Aurika ^{[13
]}

Ferreira, Rita ^{[14
]}

Carvalho, Susana ^{[14
]}

Tomescu, Dana ^{[15
]}

Martac, Cristina ^{[15
]}

Grintescu, Iona ^{[16
]}

Mirea, Liliana ^{[16
]}

Serrano, Luz ^{[17
]}

Sierra, Pilar ^{[18
]}

Sabate, Sergi ^{[18
]}

Hernando, Daniel ^{[18
]}

Matute, Purificacion ^{[19
]}

Trashorras, Monsterrat ^{[19
]}

sune, Monsterrat ^{[19
]}

Sarmiento, Laura ^{[19
]}

Hervias, Adriana ^{[19
]}

Gonzalez, Olga ^{[20
]}

Hermina, Ana ^{[20
]}

Navarro Perez, Rosalia ^{[21
]}

Orts, Mar ^{[22
]}

Fernandez-Garcia, Raquel ^{[23
]}

Sanchez Perez, David ^{[23
]}

Sepulveda Gil, Isabel ^{[23
]}

Monedero, Pablo ^{[24
]}

Hidalgo, Francisco ^{[24
]}

Mbongo, Cisse ^{[24
]}

Rodriguez Pont, Anna ^{[25
]}

Mendez Reyes, Helena ^{[25
]}

Garcia Bartolo, Carolina ^{[25
]}

机构：

[1] Univ Leeds, Leeds Inst Med Res St Jamess, Leeds, W Yorkshire, England

[2] Erasmus Univ, Med Ctr, Dept Anesthesiol, Rotterdam, Netherlands

[3] Leeds Inst Hlth Sci, Fac Med & Hlth, Leeds, W Yorkshire, England

[4] Univ Leeds, Leeds Inst Cardiovasc & Metab Res, Div Cardiovasc & Diabet Res, Leeds, W Yorkshire, England

[5] Univ Bonn, Dept Anaesthesiol & Intens Care Med, Bonn, Germany

[6] UCL Brussels, Clin Univ St Luc, Brussels, Belgium

[7] Clin Univ Mt Godinne, Yvoir, Belgium

[8] Clin St Marguerite, Hyeres, France

[9] Univ Bonn, Bonn, Germany

[10] Univ Hosp Carl Gustav Carus, Dresden, Germany

[11] Attikon Univ Hosp, Athens, Greece

[12] Univ Clin Ctr, Printina, Kosovo

[13] Lithuanian Univ Hlth Sci, Kaunas Med Univ Hosp, Kaunas, Lithuania

[14] Inst Portugues Oncol Francisco Gentil, Lisbon, Portugal

[15] Fundeni Clin Hosp, Bucharest, Romania

[16] Clin Emergency Hosp Bucharest, Bucharest, Romania

[17] Fdn Hosp Alcorcon, Madrid, Spain

[18] Fdn Puigvert, Barcelona, Spain

[19] Barcelona Univ, Hosp Clin, Barcelona, Spain

[20] Univ Hosp 12 Octubre, Madrid, Spain

[21] Hosp Infanta Leonor, Madrid, Spain

[22] Hosp La Princesa, Madrid, Spain

[23] Hosp Gen Mostoles, Madrid, Spain

[24] Clin Univ Navarra, Pamplona, Spain

[25] Hosp Sabadell, Sabadell, Spain

[26] Erasmus MC, Rotterdam, Netherlands

[27] Istanbul Univ, Istanbul Fac Med, Istanbul, Turkey

[28] Dorset Cty Hosp, Dorchester, Dorset, England

[29] Leeds Teaching Hosp NHS Trust, Leeds, W Yorkshire, England

[30] Leicester Royal Infirm NHS Trust, Leicester, Leics, England

[31] Bradford Teaching Hosp NHS Fdn Trust, Bradford, W Yorkshire, England

[32] Cty Durham & Darlington NHS Fdn Trust, Darlington, Durham, England

[33] Royal Devon & Exeter Hosp, Exeter, Devon, England

[34] Mid Yorkshire Hosp NHS Trust, Wakefield, England

[35] Hull & East Yorkshire NHS Trust, Kingston Upon Hull, N Humberside, England

[36] Kettering Gen Hosp NHS, Kettering, England

[37] York Teaching Hosp, York, N Yorkshire, England

[38] Heatherwood & Wexham Pk Hosp NHS Fdn Trust, Ascot, Berks, England

[39] Colchester Hosp Univ Fdn Trust, Colchester, Essex, England

[40] Royal Surrey Cty Hosp, Guildford, Surrey, England

[41] Harrogate Dist Hosp, Harrogate, England

[42] South Tees Hosp NHS Fdn Trust, Stockton On Tees, Cleveland, England

[43] Northern Lincolnshire & Goole Hosp NHS Trust, Scunthorpe, England

[44] North Tees & Hartlepool NHS Fdn Trust, Stockton On Tees, Cleveland, England

[45] Royal Cornwall Hosp, Truro, England

[46] Warrington Gen Hosp NHS Trust, Warrington, Cheshire, England

来源：

BRITISH JOURNAL OF ANAESTHESIA | 2019年 / 122卷 / 02期

关键词：

acetylsalicylic acid; antiplatelet therapy; bleeding; major adverse cardiovascular events; outcome; percutaneous coronary intervention; surgery; DRUG-ELUTING STENT; CARDIAC RISK; CLOPIDOGREL; PREDICTORS; MANAGEMENT; DISCONTINUATION; IMPLANTATION; METAANALYSIS; TRANSFUSION; GUIDELINES;

D O I：

10.1016/j.bja.2018.09.029

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Background: The perioperative management of antiplatelet therapy in noncardiac surgery patients who have undergone previous percutaneous coronary intervention (PCI) remains a dilemma. Continuing dual antiplatelet therapy (DAPT) may carry a risk of bleeding, while stopping antiplatelet therapy may increase the risk of perioperative major adverse cardiovascular events (MACE). Methods: Occurrence of Bleeding and Thrombosis during Antiplatelet Therapy In Non-Cardiac Surgery (OBTAIN) was an international prospective multicentre cohort study of perioperative antiplatelet treatment, MACE, and serious bleeding in noncardiac surgery. The incidences of MACE and bleeding were compared in patients receiving DAPT, monotherapy, and no antiplatelet therapy before surgery. Unadjusted risk ratios were calculated taking monotherapy as the baseline. The adjusted risks of bleeding and MACE were compared in patients receiving monotherapy and DAPT using propensity score matching. Results: A total of 917 patients were recruited and 847 were eligible for inclusion. Ninety-six patients received no antiplatelet therapy, 526 received monotherapy with aspirin, and 225 received DAPT. Thirty-two patients suffered MACE and 22 had bleeding. The unadjusted risk ratio for MACE in patients receiving DAPT compared with monotherapy was 1.9 (0.93-3.88), P = 0.08. There was no difference in MACE between no antiplatelet treatment and monotherapy 1.03 (0.31-3.46), P = 0.96. Bleeding was more frequent with DAPT 6.55 (2.3-17.96) P = 0.0002. In a propensity matched analysis of 177 patients who received DAPT and 177 monotherapy patients, the risk ratio for MACE with DAPT was 1.83 (0.69-4.85), P = 0.32. The risk of bleeding was significantly greater in the DAPT group 4.00 (1.15-13.93), P = 0.031. Conclusions: OBTAIN showed an increased risk of bleeding with DAPT and found no evidence for protective effects of DAPT from perioperative MACE in patients who have undergone previous PCI.

引用

页码：170 / 179

页数：10

共 43 条

[1] Non-cardiac surgery in patients with coronary stents: the RECO study [J].

Albaladejo, Pierre ;

Marret, Emmanuel ;

Samama, Charles-Marc ;

Collet, Jean-Philippe ;

Abhay, Kou ;

Loutrel, Olivier ;

Charbonneau, Helene ;

Jaber, Samir ;

Thoret, Sophie ;

Bosson, Jean-Luc ;

Piriou, Vincent .

HEART, 2011, 97 (19) :1566-1572

[2]

[Anonymous], BRIT NATL FORMULARY

[3]

[Anonymous], N ENGL J MED

[4]

[Anonymous], TECHN ASS

[5] The Risk of Cardiac Complications Following Noncardiac Surgery in Patients with Drug Eluting Stents Implanted at Least Six Months Before Surgery [J].

Assali, Abid ;

Vaknin-Assa, Hana ;

Lev, Eli ;

Bental, Tamir ;

Ben-Dor, Itsik ;

Teplitsky, Igal ;

Brosh, David ;

Fuchs, Shmuel ;

Eidelman, Leonid ;

Battler, Alexander ;

Kornowski, Ran .

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2009, 74 (06) :837-843

[6] A Tutorial and Case Study in Propensity Score Analysis: An Application to Estimating the Effect of In-Hospital Smoking Cessation Counseling on Mortality [J].

Austin, Peter C. .

MULTIVARIATE BEHAVIORAL RESEARCH, 2011, 46 (01) :119-151

[7] Drivers of Transfusion Decision Making and Quality of the Evidence in Orthopedic Surgery: A Systematic Review of the Literature [J].

Barr, Paul James ;

Donnelly, Michael ;

Cardwell, Chris ;

Alam, Shama Shams ;

Morris, Kieran ;

Parker, Mike ;

Elizabeth, Karen ;

Bailie, Margaret .

TRANSFUSION MEDICINE REVIEWS, 2011, 25 (04) :304-316

[8] Benefits and risks of using clopidogrel before coronary artery bypass surgery: Systematic review and meta-analysis of randomized trials and observational studies [J].

Biancari, Fausto ;

Airaksinen, K. E. Juhani ;

Lip, Gregory Y. H. .

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2012, 143 (03) :665-+

[9] Duration of Dual Antiplatelet Therapy: A Systematic Review for the 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease [J].

Bittl, John A. ;

Baber, Usman ;

Bradley, Steven M. ;

Wijeysundera, Duminda N. ;

Halperin, Jonathan L. ;

Levine, Glenn N. ;

Al-Khatib, Sana M. ;

Birtcher, Kim K. ;

Bozkurt, Biykem ;

Brindis, Ralph G. ;

Cigarroa, Joaquin E. ;

Curtis, Lesley H. ;

Fleisher, Lee A. ;

Gentile, Federico ;

Gidding, Samuel ;

Hlatky, Mark A. ;

Ikonomidis, John S. ;

Joglar, Jose A. ;

Pressler, Susan J. ;

Wijeysundera, Duminda N. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2016, 68 (10) :1116-1139

[10] Long-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction [J].

Bonaca, Marc P. ;

Bhatt, Deepak L. ;

Cohen, Marc ;

Steg, Philippe Gabriel ;

Storey, Robert F. ;

Jensen, Eva C. ;

Magnani, Giulia ;

Bansilal, Sameer ;

Fish, M. Polly ;

Im, Kyungah ;

Bengtsson, Olof ;

Ophuis, Ton Oude ;

Budaj, Andrzej ;

Theroux, Pierre ;

Ruda, Mikhail ;

Hamm, Christian ;

Goto, Shinya ;

Spinar, Jindrich ;

Nicolau, Jose Carlos ;

Kiss, Robert G. ;

Murphy, Sabina A. ;

Wiviott, Stephen D. ;

Held, Peter ;

Braunwald, Eugene ;

Sabatine, Marc S. ;

Morin, Suzanne ;

Dantzer, Emily ;

Acquilano, Dayle ;

McGuire, Rachael L. ;

Gannon, Joseph B. ;

Gershman, Elaine ;

Ahlbom, Ann Maxe ;

Boberg, Barbro ;

Abola, Maria Teresa ;

Ardissino, Diego ;

Aylward, Philip ;

Corbalan, Ramon ;

Dalby, Anthony ;

Diaz, Rafael ;

Hu, Dayi ;

Isaza, Daniel ;

Kamensky, Gabriel ;

Kiss, Robert ;

Kontny, Frederic ;

Lopez-Sendon, Jose ;

Medina, Felix ;

Montalescot, Gilles ;

Nicolau, Jose ;

Paolasso, Ernesto ;

Parkhomenko, Alexander .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (19) :1791-1800

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