Perioperative management of antithrombotic drugs in the real world: Study of the impact of not following the consensus document

Abstract

Introduction and objectives

In order to standardise the periprocedural management of antithrombotic drugs, a national and multidisciplinary consensus document was drawn up in 2018. This study analyses the follow-up of this consensus and its outcome in the perioperative setting.

Methods

Sub-analysis of the REQXAA study (observational, prospective, multicentre with 30-day follow-up) in patients scheduled for surgery. Antithrombotic management was considered appropriate according to the consensus document. Logistic regression analysis was used to study the effect of appropriate management and other variables on the incidence of adverse thrombotic and/or haemorrhagic events (odds ratio (OR) and confidence interval (95% CI)).

Results

A total of 506 patients were included (57.5% antiplatelet therapy; 38.9% anticoagulant therapy; 3.6% dual therapy), with 50 adverse events recorded (overall incidence 9.9%), 46 of which were haemorrhagic. In 50.2% of patients, management was suboptimal, which was associated with a significant increase in adverse events (OR 2.3, 95% CI 1.2–4.2). The following factors independently increased the risk: inappropriate indication for bridging therapy (OR 3.9, 95% CI 1.9–7.9), chronic kidney disease (OR 2.0, 95% CI 1.1–3.9) and high thrombotic risk (OR 3.7, 95% CI 1.6–8.6). Patients with moderate-to-high bleeding risk and suboptimal management had a higher risk of bleeding (OR 4.4, 95% CI 1.6–11.9).

Conclusions

Failure to follow the consensus document for the perioperative management of antithrombotic drugs is associated with an increase in adverse events. The implementation of multidisciplinary protocols in the perioperative period, following current recommendations, could improve these outcomes.

Resumen

Introducción y objetivos

Con el fin de homogeneizar el manejo periprocedimiento de los fármacos antitrombóticos se realizó en 2018 un documento de consenso nacional y multidisciplinario. Este estudio analiza el seguimiento de este consenso y su resultado en el ámbito perioperatorio.

Métodos

Subanálisis del estudio REQXAA (observacional, prospectivo, multicéntrico con seguimiento durante 30 días) en pacientes programados para cirugía. Se consideró idóneo el manejo de antitrombóticos según el documento de consenso. Mediante análisis de regresión logística se estudió el efecto del manejo idóneo, y otras variables, en la incidencia de eventos adversos trombóticos y/o hemorrágicos (odds ratio (OR) e intervalo de confianza (IC95%)).

Resultados

Se incluyeron 506 pacientes (57,5% antiagregados; 38,9% anticoagulados; 3,6% doble terapia), registrando 50 eventos adversos (incidencia global 9,9%), 46 de ellos hemorrágicos. En el 50,2% de los pacientes se realizó un manejo idóneo, que se asoció a un aumento significativo de eventos adversos (OR 2,3 IC95% 1,2–4,2). De forma independiente, incrementaron el riesgo: la indicación no idónea de terapia puente (OR 3,9, IC95% 1,9–7,9), la enfermedad renal crónica (OR 2,0, IC95% 1,1–3,9) y el riesgo trombótico alto (OR 3,7, IC95% 1,6–8,6). Los pacientes con riesgo hemorrágico moderado-alto y manejo no idóneo presentaron mayor riesgo de sangrado (OR 4,4, IC95% 1,6–11,9).

Conclusiones

El no seguimiento del documento de consenso para el manejo perioperatorio de los fármacos antitrombóticos se asocia a un aumento de eventos adversos. La implementación de protocolos multidisciplinares en el perioperatorio, siguiendo las recomendaciones actuales, podría mejorar dichos resultados.