Adherence to periprocedural antithrombotic treatment recommendations and its prognostic impact in patients with high ischemic and hemorrhagic risk.

Autores de IIS La Fe

• Raquel Ferrandis Comes

  Autor

• Francisco Marin Ortuño

  Autor

Participantes ajenos a IIS La Fe

• Anguita-Gamez, Maria
• Vivas, David
• Esteve-Pastor, Maria Asuncion
• Gonzalez-Manzanares, Rafael
• 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
• Moliner, Alejandra
• Rodriguez-Contreras, Rocio
• Carnero-Alcazar, Manuel
• Anguita, Manuel
• REQXAA study researchers

Grupos

• Anestesia y Cuidados Críticos

  Investigador Principal

  María Azucena Pajares Moncho

• Medicina Perioperatoria, Anestesiología y Reanimación

  

  Leader

  Óscar Díaz Cambronero

Abstract

INTRODUCTION AND OBJECTIVES: To analyze the clinical impact of the inappropriate use of antithrombotic treatment in patients with high ischemic or hemorrhagic risk during the periprocedural/perisurgical period in Spain. METHODS: Prospective multicenter observational registry of patients receiving antiplatelet and/or anticoagulant therapy who required an intervention. The incidence of 30-day events was compared based on the peri-intervention management of antithrombotic treatment and the patients' risk classification (high vs. moderate-to-low risk). The primary endpoint was a composite of death, cardiovascular ischemic events, or bleeding events classified as BARC 2 or higher. RESULTS: A total of 1152 patients were analyzed. Of these, 1.9% had both high ischemic and hemorrhagic risks (A);10.8% had high ischemic risk and low-to-moderate hemorrhagic risk (B); 12% had high hemorrhagic risk and low-to-moderate ischemic risk (C); and 75.3% had both low-to-moderate risks (D). The prevalence of inappropriate treatment was higher in the subgroup with high hemorrhagic risk and low-to-moderate ischemic risk (C) (62.6% vs 40.9% in subgroup A; P<.05; 40.3% in subgroup B; P<.001; and 39.8% in subgroup D; P<.05). The incidence of the composite endpoint was higher in the subgroups with high ischemic and hemorrhagic risks (22.7%) and high ischemic and low-to-moderate hemorrhagic risks (20.9%), compared with 3.6% in subgroup C (P<.05) and 5.7% in subgroup D (P<.001). Among patients with inappropriate treatment, the incidence of the composite endpoint was significantly higher in subgroups with high ischemic and hemorrhagic risks (44.4% vs 7.7%; P=.043) and high ischemic and low-to-moderate hemorrhagic risks (30% vs 14.8%; P=.042). CONCLUSIONS: The prevalence of inappropriate periprocedural/perisurgical treatment was higher in patients with high hemorrhagic risk and low-to-moderate ischemic risk. The incidence of events was higher in patients with high ischemic risk, with inadequate antithrombotic management being associated with a higher event rate in these groups.