ABSTRACT
Introducción y objetivos: Existe escasa evidencia acerca del impacto de las actuales recomendaciones sobre la utilización del tratamiento antitrombótico durante el periodo perioperatorio y periprocedimiento en el «mundo real». El objetivo de este estudio es analizar la utilización de los fármacos antitrombóticos en una población de pacientes que van a someterse a una cirugía/procedimiento, así como evaluar la implicación que tiene su retirada o mantenimiento en la incidencia de eventos adversos trombóticos y/o hemorrágicos. Métodos: Estudio observacional prospectivo, multicéntrico y multiespecialidad de pacientes en tratamiento antitrombótico que precisen alguna intervención. El objetivo principal fue la incidencia de eventos trombóticos y hemorrágicos a 30 días en función del uso periintervención de los fármacos antitrombóticos. Resultados: Se incluyó a un total de 1.266 pacientes (el 63,5% varones; media de edad, 72,6 años). El 48,6% de ellos se encontraban anticoagulados (la mayoría por fibrilación auricular; CHA2DS2-VASC, 3,7) y el 53,3%, antiagregados, con mayor frecuencia por cardiopatía isquémica. El 66,7% tenía un riesgo isquémico bajo y el 51,9%, un riesgo hemorrágico de la intervención bajo. El tratamiento antitrombótico periprocedimiento según las recomendaciones actuales fue idóneo únicamente en el 57,3% de los casos. Los pacientes con un uso inadecuado de los fármacos antitrombóticos periprocedimiento presentaron una incidencia de eventos adversos trombóticos y hemorrágicos significativamente mayor. Conclusiones: A pesar de las recomendaciones actuales acerca de la utilización de fármacos antitrombóticos en el periodo perioperatorio/periprocedimiento, su implementación en el «mundo real» continúa siendo baja. Un uso inadecuado se asocia con un aumento de la incidencia de eventos adversos, tanto trombóticos como hemorrágicos.(AU)
Introduction and objectives: There is scarce real-world evidence on the management of perioperative antithrombotic treatment according to current recommendations. The aim of this study was to analyze the management of antithrombotic treatment in patients undergoing surgery or another invasive intervention and to assess the consequences of this management on the occurrence thrombotic or bleeding events. Methods: This prospective, observational, multicenter and multispecialty study analyzed patients receiving antithrombotic therapy who underwent surgery or another invasive intervention. The primary endpoint was defined as the incidence of adverse (thrombotic and/or hemorrhagic) events after 30 days of follow-up with respect to management of perioperative antithrombotic drugs. Results: We included 1266 patients (male: 63.5%; mean age 72.6 years). Nearly half of the patients (48.6%) were under chronic anticoagulation therapy (mainly for atrial fibrillation; CHA2DS2-VASC: 3.7), while 53.3% of the patients were under chronic antiplatelet therapy (mainly for coronary artery disease). Low ischemic and hemorrhagic risk was found in 66.7% and 51.9%, respectively. Antithrombotic therapy management was in line with current recommendations in only 57.3% of the patients. Inappropriate management of antithrombotic therapy was an independent risk factor for both thrombotic and hemorrhagic events. Conclusions: The implementation of recommendations on the perioperative/periprocedural management of antithrombotic therapy in real-world patients is poor. Inappropriate management of antithrombotic treatment is associated with an increase in both thrombotic and hemorrhagic events.(AU)
Subject(s)
Humans , Male , Female , Aged , Perioperative Period/methods , Fibrinolytic Agents , Anticoagulants , General Surgery , Drug Therapy , Prospective Studies , Cardiology , Heart DiseasesABSTRACT
INTRODUCTION AND OBJECTIVES: There is scarce real-world evidence on the management of perioperative antithrombotic treatment according to current recommendations. The aim of this study was to analyze the management of antithrombotic treatment in patients undergoing surgery or another invasive intervention and to assess the consequences of this management on the occurrence thrombotic or bleeding events. METHODS: This prospective, observational, multicenter and multispecialty study analyzed patients receiving antithrombotic therapy who underwent surgery or another invasive intervention. The primary endpoint was defined as the incidence of adverse (thrombotic and/or hemorrhagic) events after 30 days of follow-up with respect to management of perioperative antithrombotic drugs. RESULTS: We included 1266 patients (male: 63.5%; mean age 72.6 years). Nearly half of the patients (48.6%) were under chronic anticoagulation therapy (mainly for atrial fibrillation; CHA2DS2-VASC: 3.7), while 53.3% of the patients were under chronic antiplatelet therapy (mainly for coronary artery disease). Low ischemic and hemorrhagic risk was found in 66.7% and 51.9%, respectively. Antithrombotic therapy management was in line with current recommendations in only 57.3% of the patients. Inappropriate management of antithrombotic therapy was an independent risk factor for both thrombotic and hemorrhagic events. CONCLUSIONS: The implementation of recommendations on the perioperative/periprocedural management of antithrombotic therapy in real-world patients is poor. Inappropriate management of antithrombotic treatment is associated with an increase in both thrombotic and hemorrhagic events.
Subject(s)
Anticoagulants , Atrial Fibrillation , Humans , Male , Aged , Anticoagulants/therapeutic use , Fibrinolytic Agents/therapeutic use , Fibrinolytic Agents/adverse effects , Prospective Studies , Hemorrhage/chemically induced , Hemorrhage/epidemiology , Hemorrhage/complications , Risk Factors , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Registries , Platelet Aggregation Inhibitors/adverse effectsABSTRACT
BACKGROUND: High compliance within enhanced recovery protocols is associated with lower complication rates. Understanding which clinical characteristics make patients more prone to fail adequate adherence to enhanced recovery after surgery guidelines are essential to improve quality care. Our aim was to identify patient characteristics that influence adherence to enhanced recovery protocols in colorectal surgery. METHODS: A total of 1041 patients underwent colorectal surgery under ERPs from September 2017 through December 2017 across 21 institutions in Spain. Demographic, medical, and surgical characteristics of the patients included were extracted to determine their influence on the adherence to enhanced recovery protocols. High adherence was defined as ≥ 73% (median). A univariate analysis was performed initially, followed by multivariable logistic regression analysis. RESULTS: Over 85% of the patients underwent colorectal surgery for cancer resection, of which 12% had metastatic disease. In multivariable model, the presence of coronary artery disease (aOR 1.79, 95% CI 1.12-2.96, p = 0.045) was significantly associated with high adherence to enhanced recovery protocols, while preoperative hypoalbuminemia (aOR 0.55, 95% CI 0.37-0.82, p = 0.003), indication for ostomy (aOR 0.55, 95% CI 0.4-0.75, p < 0.001), and preoperative transfusion (aOR 0.48, 95% CI 0.26-0.91, p = 0.02) were associated with lower adherence. CONCLUSION: In this study, patients that had preoperative transfusions, preoperative hypoalbuminemia, and indication for ostomy were more likely to receive care with less adherence to enhanced recovery protocols elements, while patients with coronary artery disease were more likely to receive more enhanced recovery protocols elements during their hospitalization.
