• Medicina clinica · Jul 2024

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

    • María Anguita-Gámez, David Vivas, Raquel Ferrandis, Rafael González-Manzanares, Manuel Anguita, María Asunción Esteve-Pastor, Marysol Echeverri, Jesús Igualada, Isabel Egocheaga, Beatriz Nozal-Mateo, Ane Abad-Motos, Elena Figuero, Nuria Bouzó-Molina, Teresa Lozano, Carlos Álvarez-Ortega, Javier Torres, María José Descalzo, Juan Carlos Catalá, Enrique Martín-Rioboo, Alejandra Molines, Rocío Rodríguez-Contreras, Manuel Carnero-Alcázar, Francisco Marín, and REQXAA Investigators.
    • Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain. Electronic address: maria.anguita95@gmail.com.
    • Med Clin (Barc). 2024 Jul 1.

    Background And AimsThere 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.MethodsA 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.ResultsWe 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.ConclusionsDespite 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.Copyright © 2024 Elsevier España, S.L.U. All rights reserved.

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