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

Data de publicació: 08/11/2024

Autors de IIS La Fe

Raquel Ferrandis Comes

Autor
Francisco Marin Ortuño

Autor

Autors aliens 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

Grups d'Investigació

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.