A multicentric, retrospective, outcome analysis of contemporary antiplatelet discontinuation practices in coronary artery disease patients undergoing cardiac / non cardiac surgeries

摘要

Background: Patients with coronary artery disease (CAD) posescardiologists, surgeons, and anesthetists with the dilemma ofdeciding between the risk of increased blood loss whencontinuing antiplatelet agents in the perioperative period, and therisk of thromboembolic events if the drugs are stopped.Aim: Analysis of the data, on the current practices of continuationor discontinuation of anti-platelets in CAD patients undergoingcardiacon-cardiac surgery. In addition to observe adverseevents resulting from this practice.Methods: Multi centric, retrospective, observational study conductedin three tertiary care centers of India. A minimum 1537 patientswith CAD undergoing surgeries will be included in the study.The Primaryoutcome of the study isperi-operative thromboembolicevents - stroke, pulmonary embolism, deep vein thrombosis andacute coronary syndromes and the secondary outcome is Perioperativebleeding. Bleedingwasclassified asmajor (Type 2 to 5) andminor (Type 0 and 1) as per the BARC definition of bleeding.Results: In this ongoing study 513 patients have been enrolled.The average age of the patients was 62 yr out of these 85.4% weremale. 414 (80.7 %) of patient underwent cardiac surgery and 99(19.3%) patient underwent noncardiac surgery.Of the patient who underwent cardiac surgery 352 (85 %) discontinuedthe anti platelet therapy while 40 (40.4 %) underwentnon cardiac surgery after discontinuing antiplatelets.In cardiac surgery patient population , major bleeding occurredin 6.0% in discontinuation group vs 3.2 % of patients in continuationgroup (p ?0.302). In non cardiac surgery population, majorbleeding were nil in both continuation and discontinuation group.Conclusion: Antiplatelet was discontinued more often in patientswho underwent cardiac group. There was no significance in thebleeding. Thrombotic events were not influenced by discontinuationof antiplatelets.