ABSTRACT
Objective:To analyze the effect of anticoagulant or antiplatelet drugs on bleeding and cardio-cerebral vascular events in perioperative period of catherization for peritoneal dialysis.Methods:The clinical data of patients undergoing peritoneal dialysis catheterization in Peking University Third Hospital from July 1, 2010 to December 31, 2020 were collected and analyzed retrospectively. The patients were divided into drugs discontinuation group and drugs continuation group according to whether the anticoagulant drugs or antiplatelet drugs were discontinued or not. Baseline clinical data and bleeding and cardio-cerebral events after surgery were compared between the two groups. Multivariate logistic regression model was used to analyze the influencing factors for bleeding and cardio-cerebral events.Results:A total of 57 patients were included in the study, with 34 males and 23 females. The age was (67.37±13.93) years old (range from 27 to 97 years old). There were 37 patients in drugs discontinuation group and 20 patients in drugs continuation group. The proportions of acute myocardial infarction events in drugs continuation group were higher than those in drugs discontinuation group in 3 months and 6 months before surgery (10/20 vs 3/37, χ2=10.671, P=0.001; 11/20 vs 3/37, χ2=12.980, P<0.001 respectively). The median drugs discontinuation time was 5.0(2.0, 14.0) d (range from 1 to 30 d) before surgery, and median restore medication time was 4.0(3.0, 7.0) d (range from 1 to 14 d) after surgery in drugs discontinuation group. There was no significant difference in the proportion of bleeding (10/37 vs 8/20, χ2=1.011, P=0.315) and cardio-cerebral events (4/37 vs 0/20, χ2=0.964, P=0.326) between drugs discontinuation group and drugs continuation group within 2 weeks after surgery. The results of multivariate logistic regression analysis showed that drugs discontinuation before surgery was not an independent influencing factor for bleeding events ( OR=0.656, 95% CI 0.195-2.206, P=0.496), however combination of aspirin and clopidogrel before surgery was an independent influencing factor for bleeding events ( OR=4.038, 95% CI 1.044-15.626, P=0.043). All cardio-cerebral events (4 cases) happened in drugs discontinuation group, and myocardial angina in 6 months before surgery ( OR=9.764, 95% CI 0.928-102.682, P=0.058) and increased serum calcium concentration ( OR=1.491, 95% CI 0.976-2.278, P=0.065) were related with an elevated trend for cardio-cerebral events. Conclusions:Whether anticoagulant or antiplatelet drugs are discontinued before catherization surgery for peritoneal dialysis is not an independent influencing factor for bleeding events after surgery. The risk of postoperative bleeding in patients using combination of aspirin and clopidogrel should be paid attention. Myocardial angina in 6 months before surgery and higher serum calcium are related with an elevated trend for cardio-cerebral events after drugs discontinuation.
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Objective To investigate the relationship between brachial ankle pulse wave velocity and the incidence of cardio-cerebral events in people aged over 40. Methods Cluster sampling method was used to prospectively study 4 380 residents aged over 40 in Guiyang City District from May to August in 2011. Data of ba-PWV were collected. The follow-up examination was conducted from July to November of 2014. According to ba-PWV values, participants were divided into three groups:<14 m/s (control, n=1 039) group, 14-17.9 m/s group (n=1 393) and≥18 m/s group (n=809). Multi-factor Logistic regression model was used to analyze the relationship between ba-PWV values and risk factors of cardio-cerebral events. Results After three-year follow-up, a total of 3 241 participants were included in the final analysis. The cardio-cerebral events were identified in 63 (2.0%) cases, which were 0.6%, 2.2%and 3.2%in control group, 14-17.9 m/s group and≥18 m/s group. The value of ba-PWV increased significantly in those two groups compared with that of normal group. Logistic regression analysis showed that the incidence rates of cardiovascular and cerebralvascular events in 14-17.9 m/s group and≥18 m/s group were 2.777 (1.123-6.864) and 2.786 (1.032-7.526) times of control group after adjusting age, gender, systolic blood pressure, risk factors of diabetes, hypertension and blood lipids. Conclusion There is higher incidence rate of cardio-cerebral events in people aged over 40 in higher ba-PWV group. The value of Ba-PWV can be used to predict the occurrence of cardio-cerebral events.
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Objective To compare two different revascularization methods in type 2 diabetes mellitus (T2DM) patients with multivessel coronary artery disease treated by percutaneous coronary intervention (PCI) and coronary artery bypass graft ( CABG) .Methods T2DM patients with multivessel disease undergoing success-ful PCI or CABG were enrolled in the study .They were diagnosed by coronary angiography ( CAG) in Tianjin Chest Hospital from May 2009 to May 2010 whose.The patients were followed up for 3 years.The information of patients including physical performance , clinical features , and laboratory examination results were collected .The major ad-verse cardio cerebral events(MACCE)including death, myocardial infarction(MI), revascularization, angina pecto-ris, heart failure, and stroke were collected.Results During the 3 years of follow-up, MACCE(31.58% vs 17.68%, P<0.01), death(4.82%vs 1.10%, P<0.05), MI(4.39%vs 1.10%, P<0.05), angina pectoris (17.27%vs 10.50%, P<0.05)occurred more frequently in PCI group than in CABG group .Conclusion Evi-dences now tend to support CABG for revascularization in T 2DM patients with multivessel disease .