Incidence and clinical impact of inappropriate periprocedural and perioperative management of antiplatelet therapy.

BACKGROUND AND AIMS: There is little evidence on the impact of current recommendations on the use of antiplatelet therapy during the perioperative and periprocedural period in our setting. The aim of this study was to analyze the incidence and clinical impact of inappropriate use of antiplatelet therapy in a population of patients undergoing surgery or a diagnostic or therapeutic procedure in "real life" in Spain. METHODS: A prospective multicenter observational study of patients treated with antiplatelet agents requiring intervention was conducted. The incidence of thrombotic and hemorrhagic events at 30 days was analyzed according to peri-intervention management of antiplatelet therapy. RESULTS: We included 643 patients (31.9% women, 39.0% over 75 years of age), most of them (87.7%) receiving aspirin as antiplatelet therapy at a dose of 100mg/day. Indications for antiplatelet therapy were ischemic heart disease (44.9%), cerebrovascular disease (21.7%), and peripheral vascular disease (23.0%). Ischemic risk was low in 74.3%, while 51.6% had a low bleeding risk of the intervention. Periprocedural management was considered appropriate in 61.7% of cases. 30-day incidence of the combined primary endpoint of thrombotic events and major bleeding (12.1% versus 5.0%; p=0.002) and 30-day mortality (5.2% versus 1.5%; p=0.008) were significantly higher in patients with inappropriate periprocedural management of antiplatelet agents. CONCLUSIONS: Despite current recommendations for the use of antiplatelet drugs in the perioperative/periprocedural period, their implementation in the "real world" remains low. Inappropriate use is associated with an increased incidence of adverse events, both thrombotic and hemorrhagic.

Prospective observational registry of perioperative and periprocedural management of antithrombotic therapy in "real world": the REQXAA study.

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.

Intervención basada en mindfulness a través de una app móvil para personas con cáncer colorrectal en espera de cirugía: ensayo clínico aleatorizado / Mindfulness based intervention through mobile app for colorectal cancer people awaiting surgery: A randomized clinical trial

Introducción: El cáncer colorrectal representa el tercer cáncer con mayor incidencia en ambos sexos. Un tercio de los pacientes con cáncer experimentan sintomatología ansiosa o depresiva. El objetivo de este estudio fue evaluar la eficacia de una intervención de reducción de estrés basada en mindfulness a través de una aplicación móvil (En calma en el quirófano). Método: Es un ensayo controlado, aleatorizado, con evaluador ciego y multicéntrico, que compara la eficacia de una aplicación de entrenamiento en mindfulness para móviles (rama experimental) con tratamiento habitual (rama control), en 3tiempos de medida (T0 o línea base, T1 o alta a domicilio, T2 o un mes tras cirugía). Se evaluó la sintomatología ansiosa y depresiva (HADS), la calidad de vida (WHOQOL), la escala de dolor (EVA) y la escala de satisfacción (CSQ). Resultados: Hubo un total de 270 derivaciones. Fueron analizadas 82 personas: 39 personas utilizaron la app y 43 continuaron su tratamiento habitual. No hubo cambios significativos entre grupos ni tiempos de medida. Se observó una ligera tendencia en la que el grupo experimental tuvo menos síntomas de depresión y ansiedad entre T0 y T2 (B?= −0,2; IC 95%: 8,8-9,2). Conclusiones: Nuestra población mostraba una edad media alta (65 años), niveles bajos de ansiedad y depresión, y niveles medios de calidad de vida en T0. Estos factores podrían haber interactuado y limitado la eficacia de la app. Nuevas líneas de investigación tienen que ir dirigidas a evaluar la eficacia de las apps para pacientes con enfermedades quirúrgicas en poblaciones más jóvenes. (AU)

Introduction: Colorectal cancer is the third most common cancer worldwide that occurs both in men and women. Around one-third of patients with cancer will suffer from anxiety or depression symptoms. The aim of this study was to evaluate the effectiveness of a mindfulness-based stress reduction intervention through a mobile application («en calma en el quirófano»). Method: This study is a multicenter, single-blind (evaluator), controlled, randomized trial that compares the effectiveness of a mindfulness training through a mobile application (intervention group) and treatment as usual (control group) in 3different moments (T0 or baseline, T1 or hospital discharge and T2 or one month after surgery). Hospital Anxiety and depression Scale (HADS), quality of life (WHOQOL), pain (VAS) and satisfaction (CSQ) were assessed. Results: In all, there were 270 referred patients. Among them, 39 and 43 were assigned to the intervention and control groups respectively; 82 patients were analyzed: 39 patients used the app, and 43 patients continued with the treatment as usual. There were no significant changes between groups and time. We observed a slight trend in which intervention group had less depression and anxiety symptoms since T0 and T2 (B=−0.2; 95% CI: 8.8-9.2). Conclusions: The sample of this study had a high mean age (65 years old), and low levels of anxiety and depression and medium levels of pre-surgery quality of life in baseline. These factors could have influenced limiting the effectiveness of the app. Prospective research lines should focus on evaluating the effectiveness of mobile applications for younger patients with surgical pathologies. (AU)

Mindfulness based intervention through mobile app for colorectal cancer people awaiting surgery: A randomized clinical trial.

INTRODUCTION: Colorectal cancer is the third most common cancer worldwide both in men and women. Around one-third of patients with cancer will suffer from anxiety or depression symptoms. The aim of this study was to evaluate the effectiveness of a Mindfulness-based stress reduction intervention through a mobile application ("En Calma en el Quirófano"). METHOD: This study is a multicenter, single-blind (evaluator), controlled, randomised trial that compares the effectiveness of a mindfulness training through a mobile application (intervention group) and treatment as usual (control group) in three different moments (T0 or baseline, T1 or hospital discharge and T2 or one month after surgery). Anxiety and depression symptoms (HADS), quality of life (WHOQOL), pain, (VAS) and satisfaction (CSQ) were assessed. RESULTS: In all, there were 270 referred patients. Among them, 39 and 43 were assigned to the intervention and control groups respectively. 82 patients were analyzed: 39 patients used the app, and 43 patients continued with the treatment as usual. There were no significant changes between groups and time. We observed a slight trend in which intervention group had less depression and anxiety symptoms since T0 and T2 (B = -0.2; 95% CI between 8.8 and 9.2). CONCLUSIONS: The sample of this study had a high mean age (65 years old), and low levels of anxiety and depression and medium levels of pre-surgery quality of life in baseline. These factors could have influenced limiting the effectiveness of the app. Prospective research lines should focus on evaluating the effectiveness of mobile applications for younger patients with surgical pathologies.