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@article{1203670,
author = {Widimský, P. and Moťovská, Z. and Havlůj, L. and Ondráková, M. and Bartoška, R. and Bittner, L. and Dušek, Ladislav and Džupa, V. and Knot, J. and Krbec, M. and Mencl, L. and Pachl, J. and Grill, R. and Haninec, P. and Waldauf, P. and Gürlich, R.},
article_location = {Houten},
article_number = {9},
doi = {http://dx.doi.org/10.1007/s12471-014-0575-3},
keywords = {Antithrombotic therapy; Aspirin; Non-cardiac surgery; Perioperative bleeding; Perioperative ischemia; Thienopyridines; Thrombosis; Warfarin},
language = {eng},
issn = {1568-5888},
journal = {Netherlands Heart Journal},
title = {Perioperative cardiovascular complications versus perioperative bleeding in consecutive patients with known cardiac disease undergoing non-cardiac surgery. Focus on antithrombotic medication. The PRAGUE-14 registry},
volume = {22},
year = {2014}
}
TY - JOUR
ID - 1203670
AU - Widimský, P. - Moťovská, Z. - Havlůj, L. - Ondráková, M. - Bartoška, R. - Bittner, L. - Dušek, Ladislav - Džupa, V. - Knot, J. - Krbec, M. - Mencl, L. - Pachl, J. - Grill, R. - Haninec, P. - Waldauf, P. - Gürlich, R.
PY - 2014
TI - Perioperative cardiovascular complications versus perioperative bleeding in consecutive patients with known cardiac disease undergoing non-cardiac surgery. Focus on antithrombotic medication. The PRAGUE-14 registry
JF - Netherlands Heart Journal
VL - 22
IS - 9
SP - 372-379
EP - 372-379
PB - Bohn Stafleu van Loghum
SN - 15685888
KW - Antithrombotic therapy
KW - Aspirin
KW - Non-cardiac surgery
KW - Perioperative bleeding
KW - Perioperative ischemia
KW - Thienopyridines
KW - Thrombosis
KW - Warfarin
N2 - Background Interruption of antithrombotic treatment before surgery may prevent bleeding, but at the price of increasing cardiovascular complications. This prospective study analysed the impact of antithrombotic therapy interruption on outcomes in non-selected surgical patients with known cardiovascular disease (CVD). Methods All 1200 consecutive patients (age 74.2±10.2 years) undergoing major non-cardiac surgery (37.4 % acute, 61.4 % elective) during a period of 2.5 years while having at least one CVD were enrolled. Details on medication, bleeding, cardiovascular complications and cause of death were registered. Results In-hospital mortality was 3.9 % (versus 0.9 % mortality among 17,740 patients without CVD). Cardiovascular complications occurred in 91 (7.6 %) patients (with 37.4 % case fatality). Perioperative bleeding occurred in 160 (13.3 %) patients and was fatal in 2 (1.2 % case fatality). Multivariate analysis revealed age, preoperative anaemia, history of chronic heart failure, acute surgery and general anaesthesia predictive of cardiovascular complications. For bleeding complications multivariate analysis found warfarin use in the last 3 days, history of hypertension and general anaesthesia as independent predictive factors. Aspirin interruption before surgery was not predictive for either cardiovascular or for bleeding complications. Conclusions Perioperative cardiovascular complications in these high-risk elderly all-comer surgical patients with known cardiovascular disease are relatively rare, but once they occur, the case fatality is high. Perioperative bleeding complications are more frequent, but their case fatality is extremely low. Patterns of interruption of chronic aspirin therapy before major non-cardiac surgery are not predictive for perioperative complications (neither cardiovascular, nor bleeding). Simple baseline clinical factors are better predictors of outcomes than antithrombotic drug interruption patterns.
ER -
WIDIMSKÝ, P., Z. MOŤOVSKÁ, L. HAVLŮJ, M. ONDRÁKOVÁ, R. BARTOŠKA, L. BITTNER, Ladislav DUŠEK, V. DŽUPA, J. KNOT, M. KRBEC, L. MENCL, J. PACHL, R. GRILL, P. HANINEC, P. WALDAUF a R. GÜRLICH. Perioperative cardiovascular complications versus perioperative bleeding in consecutive patients with known cardiac disease undergoing non-cardiac surgery. Focus on antithrombotic medication. The PRAGUE-14 registry. \textit{Netherlands Heart Journal}. Houten: Bohn Stafleu van Loghum, 2014, roč.~22, č.~9, s.~372-379. ISSN~1568-5888. Dostupné z: https://dx.doi.org/10.1007/s12471-014-0575-3.
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