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

Fecha de publicación: 18/10/2024 Fecha Ahead of Print: 01/07/2024

Autores de IIS La Fe

Raquel Ferrandis Comes

Autor
Francisco Marin Ortuño

Autor

Participantes ajenos a IIS La Fe

Anguita-Gamez, Maria
Vivas, David
Gonzalez-Manzanares, Rafael
Anguita, Manuel
Esteve-Pastor, Maria Asuncion
Echeverri, Marysol
Igualada, Jesus
Egocheaga, Isabel
Nozal-Mateo, Beatriz
Abad-Motos, Ane
Figuero, Elena
Bouzo-Molina, Nuria
Lozano, Teresa
Alvarez-Ortega, Carlos
Torres, Javier
Descalzo, Maria Jose
Catala, Juan Carlos
Martin-Rioboo, Enrique
Molines, Alejandra
Rodriguez-Contreras, Rocio
Carnero-Alcazar, Manuel
REQXAA Investigators

Grupos

Anestesia y Cuidados Críticos

Investigador Principal

María Azucena Pajares Moncho
Medicina Perioperatoria, Anestesiología y Reanimación

Leader

Óscar Díaz Cambronero

Abstract

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.