Incidence and Management of Thrombotic and Thromboembolic Complications Following the Superior Cavopulmonary Anastomosis Procedure: A Literature Review

The objective of this literature review was to estimate the incidence of thrombosis and thromboembolism associated with the superior cavopulmonary anastomosis (SCPA) procedure and its variants and to examine current thromboprophylaxis regimens utilized. MEDLINE and EMBASE were searched from inception to August 2017 for all prospective and retrospective cohort studies explicitly reporting incidence of thrombosis, thromboembolism, or shunt occlusion in neonates, infants, and children undergoing 1 or more variants of the SCPA procedure. End points included thrombotic events and thromboembolic events (strokes and pulmonary embolisms) as primary outcomes, and overall mortality as a secondary outcome, at the last available follow-up time point. Of 1303 unique references identified, 13 cohort studies were deemed eligible. Reported incidence of thrombosis and thromboembolic events ranged from 0% to 28.0% and from 0% to 12.5%, respectively. Reported incidence of major bleeding events ranged from 0% to 2.9%. Reported overall mortality ranged from 2.5% to 50.5% across studies. Thromboprophylaxis protocols varied across institutions and studies, most commonly involving unfractionated heparin (UFH), warfarin, enoxaparin, acetylsalicylic acid (ASA), or combinations of ASA and warfarin, ASA and low-molecular-weight heparin (LMWH), UFH and LMWH, and UFH and ASA; several studies did not specify a protocol. Due to substantial variability in reported event rates, no clear correlation was identified between prophylaxis protocols and postoperative thrombotic complications. Despite guidance recommending postoperative UFH as standard practice, thromboprophylaxis protocols varied across institutions and studies. More robust trials evaluating different thromboprophylaxis regimens for the management of these patients are warranted.

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Effect of Metformin and Statin Use on Survival in Pancreatic Cancer Patients: a Systematic Literature Review and Meta-analysis

Current Medicinal Chemistry ◽

10.2174/0929867324666170412145232 ◽

2018 ◽

Vol 25 (22) ◽

pp. 2595-2607 ◽

Cited By ~ 21

Author(s):

E Jian-Yu ◽

Judith M. Graber ◽

Shou-En Lu ◽

Yong Lin ◽

Grace Lu-Yao ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Literature Review ◽

Cohort Studies ◽

Cancer Patients ◽

Retrospective Cohort ◽

Meta Analysis ◽

Significant Heterogeneity ◽

Retrospective Cohort Studies ◽

Statin Use

Background and Objective: Current epidemiological studies report conflicting results for the effect of statin or metformin on pancreatic cancer overall survival. This literature review and meta-analysis summarize the studies reporting an association between statin or metformin use and overall survival of pancreatic cancer patients. Methods: We systematically searched for studies about the association between statin or metformin use and pancreatic cancer overall survival in electronic databases (PubMed, ISI Web of Science, MEDLINE, Cochrane, Scopus, Google Scholar). A meta-analysis based on hazard ratios (HRs) and 95% confidence intervals (CIs) was performed using random effect models. Heterogeneity between the studies was examined using I2 statistics, and sensitivity analyses were conducted to assess the robustness of the findings. Results: Of 116 statin-related articles identified, 6 retrospective cohort studies representing 12,057 patients were included. There was significant heterogeneity between studies. Statin use was associated with improved survival among pancreatic cancer patients (meta-HR = 0.75; 95% CI: 0.59, 0.90; P < 0.001). Of 311 metformin-related articles, 8 retrospective cohort studies and 2 randomized clinical trials, representing 3,042 patients were identified. Metformin use was associated with better overall survival among pancreatic cancer patients (meta-HR = 0.79; 95% CI: 0.70, 0.92, P < 0.001), and significant heterogeneity was observed between studies. Conclusion: Our findings suggest that the improved survival time of pancreatic cancer patients are associated with statin or metformin use. Due to the multiple sources of heterogeneity of the original studies, these findings should be considered cautiously, and confirmed with larger prospective individual-level studies.

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Efficacy of Therapeutic Dose Versus Prophylactic Dose of Anticoagulants in the Primary Prevention of Thrombotic Events in Ambulatory Patients with Solid Malignancies Receiving Chemotherapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Blood ◽

10.1182/blood.v124.21.4275.4275 ◽

2014 ◽

Vol 124 (21) ◽

pp. 4275-4275

Author(s):

Nay Min Tun ◽

Elizabeth Guevara ◽

Thein H. Oo

Keyword(s):

Major Bleeding ◽

Therapeutic Dose ◽

Meta Analysis ◽

Secondary Outcome ◽

Control Groups ◽

Bleeding Events ◽

Solid Malignancies ◽

Therapeutic Doses ◽

And Control ◽

Overall Mortality

Abstract Background: Vascular thromboembolism (VTE) is a recognized complication of cancer. Clinical trials have demonstrated varying degrees of efficacy of antithrombotic agents in preventing VTE in patients suffering from cancer. Benefit of anticoagulants was found to be more pronounced among patients who are at a higher risk for VTE such as patients with advanced cancer and patients undergoing chemotherapy and/or radiotherapy. However, the optimal dose of anticoagulants used in these settings remains unknown. Therefore, we have performed a systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy of different dosing of anticoagulants in the primary prevention of VTE among patients with advanced solid malignancies receiving chemotherapy. Methods: We undertook an extensive electronic database search using PUBMED and EMBASE databases for eligible studies. RCTs, involving patients with advanced solid malignancies receiving chemotherapy, which reported VTE rates as a primary or secondary outcome were included. RCTs that had a mixed population of patients such as all stages of cancer, solid and hematologic cancers, and chemotherapy and non-chemotherapy patients were excluded. The primary outcomes in this analysis were all reported VTE events and major bleeds. The secondary outcome was overall mortality rate. We used Comprehensive Meta-analysis Version 2 (Biostat, Englewood NJ) to estimate the pooled event-based risk ratio (RR) and risk difference (RD) with 95% confidence interval (CI) by using Mantel-Haenszel method. Random effects model was applied because of heterogeneity among the studies. Results: Eight RCTs comprising 6,492 patients (5 RCTs using prophylactic dose (n = 5,556), 1 RCT using semi-therapeutic dose (n = 312), 2 RCTs using therapeutic dose (n = 624)) are eligible for analysis. The duration of thromboprophylaxis ranged from 6 weeks to 6 months. The crude VTE rates were 2.65% and 5.66% in thromboprophylaxis and control groups, respectively, with an overall RR of 0.48 (CI = 0.36 – 0.64). RRs for VTE in patients receiving prophylactic, semi-therapeutic and therapeutic doses of anticoagulants were 0.48 (CI = 0.33 – 0.68), 0.35 (CI = 0.16 – 0.75) and 0.62 (CI = 0.33 – 1.16), respectively. The RRs of these subgroups were not significantly different from one another (p = 0.518). The overall RD was -0.024 (CI = -0.033 – -0.016), suggesting an estimated number needed to treat (NNT) of 42 (CI = 30 – 63) to prevent one VTE event. RRs for major bleeding across different antithrombotic doses were not statistically different (p = 0.44) with RRs of 1.1 (CI = 0.69 – 1.75), 0.63 (CI = 0.29 – 1.37) and 1.16 (CI = 0.52 – 2.58) for prophylactic, semi-therapeutic and therapeutic doses, respectively. The overall RR for major bleeding was 0.99 (CI = 0.69 – 1.41). There was no difference in mortality rate between thromboprophylaxis and control groups (RR = 0.98, CI = 0.92 – 1.04, p = 0.42). However, there was a nonsignificant trend towards improvement in mortality in the therapeutic dose subgroup (RR = 0.9, CI = 0.78 – 1.05, p = 0.17). Conclusions: Our meta-analysis demonstrated that, among patients with advanced solid malignancies receiving chemotherapy, primary thromboprophylaxis with anticoagulants significantly reduced VTE events without an increase in major bleeding events compared to control, even though an overall survival benefit was not observed. The benefit in VTE reduction, the risk of major bleeding events and the incidence of overall mortality were similar among the three dosing regimens. However, it was noted that there was a nonsignificant trend towards survival advantage in the therapeutic dose subgroup. Figure 1 Figure 1. Figure 2 Figure 2. Figure 3 Figure 3. Disclosures No relevant conflicts of interest to declare.

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Outcomes of Ivermectin in the treatment of COVID-19: a systematic review and meta-analysis

10.1101/2021.01.26.21250420 ◽

2021 ◽

Author(s):

Alex Castañeda-Sabogal ◽

Diego Chambergo-Michilot ◽

Carlos J. Toro-Huamanchumo ◽

Christian Silva-Rengifo ◽

José Gonzales-Zamora ◽

...

Keyword(s):

Cohort Studies ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Case Series ◽

Risk Of Bias ◽

Hospitalized Patients ◽

Secondary Outcome ◽

Inverse Variance ◽

Retrospective Cohort Studies ◽

Meta Analyses

AbstractBackgroundTo assess the outcomes of ivermectin in ambulatory and hospitalized patients with COVID-19.MethodsFive databases and websites for preprints were searched until January 2021 for randomized controlled trials (RCTs) and retrospective cohorts assessing ivermectin versus control in ambulatory and hospitalized participants. The primary outcome was overall mortality. Secondary outcome was recovered patients. For meta-analysis, random-effects and inverse variance meta-analyses with logarithmic transformation were performed. ROBINS-I for cohort studies, and the Cochrane Risk of Bias 2.0 tool for trials were used. The strength of evidence was assessed using GRADE.ResultsAfter the selection, twelve studies (five retrospective cohort studies, six randomized clinical trials and one case series), were included. In total, 7412 participants were reported, the mean age was 47.5 (SD 9.5) years, and 4283 (58%) were male. Ivermectin was not associated with reduced mortality (logRR: 0.89, 95% CI 0.09 to 1.70, p = 0.04, I2= 84.7%), or reduced patient recovery (logRR 5.52, 95% CI -24.36 to 35.4, p = 0.51, I2 = 92.6%). All studies had a high risk of bias, and showed a very low certainty of the evidence.ConclusionsThere insufficient certainty and quality of evidence to recommend the use of ivermectin to prevent or treat ambulatory or hospitalized patients with COVID-19.

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Anticoagulation after VA-ECMO decannulation, providing new insights

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.168 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

A Maestro-Benedicto ◽

A Duran-Cambra ◽

M Vila-Perales ◽

J Sans-Rosello ◽

J Carreras-Mora ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Anticoagulation Therapy ◽

Thromboembolic Events ◽

Bleeding Events ◽

Membrane Oxygenation ◽

Funding Sources ◽

Va Ecmo ◽

A Prospective Study

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an essential tool for the management of refractory cardiogenic shock. Little is known about the incidence of thromboembolic events after V-A ECMO decannulation, although some studies report a high incidence of cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation (VV-ECMO). Due to this fact, in our institution anticoagulation therapy is systematically prescribed for at least 3 months after VA-ECMO per protocol. AIM The main objective of this study was to explore the feasibility of 3-month anticoagulation therapy after VA-ECMO decannulation. METHODS We performed a prospective study that included 27 consecutive patients who were successfully treated with VA-ECMO in a medical ICU between 2016 and 2019 and were prescribed 3-month anticoagulation therapy per protocol after decannulation. Exclusion criteria was dying on ECMO or while on the ICU. Data analysis included demographics, mean days on ECMO, 3-month survival, and thromboembolic and bleeding events (excluding immediate post-decannulation bleeding, since anticoagulation was prescribed 24h after). RESULTS Our cohort consisted mainly of men (N = 21, 78%), with a mean age of 60 ± 11 years and a mean time on VA-ECMO of 8 ± 3 days, who primarily suffered from post-cardiotomy cardiogenic shock (N = 9, 34%) or acute myocardial infarction (N = 6, 23%). 5 patients (18%) received a heart transplant. Regarding anticoagulation, 15 patients (60%) had other indications apart from the protocol, like incidental thrombus diagnosis (N = 7, 26%) or valve surgery (N = 5, 18%). Anticoagulation therapy was not feasible in 1 patient (4%) with severe thrombopenia. No patients had severe or life-threatening bleeding events in the follow-up, although 8 patients (30%) had bleeding events, mainly gastrointestinal bleeding (N = 4, 15%), requiring withdrawal of anticoagulation in 1 patient. The incidence of thromboembolic events was 7%; two patients with low-risk pulmonary embolisms. During the 3-month follow-up survival rate was 95%. CONCLUSIONS This is the only study to date addressing the strategy of 3-month anticoagulation therapy after VAECMO, showing it is feasible and safe and may be helpful in reducing or ameliorate thromboembolic complications in the follow-up, although it is not exempt of complications. Abstract Figure. Kaplan-Meier survival analysis

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Antibiotic Use at the End-of-Life in Patients with Advanced Dementia: A Systematic Literature Review

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.627 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s120-s120

Author(s):

Alexandre Marra ◽

Mireia Puig-Asensio ◽

Eli Perencevich

Keyword(s):

Literature Review ◽

Cohort Studies ◽

End Of Life ◽

Systematic Literature Review ◽

End Of Life Care ◽

Final Analysis ◽

Antibiotic Use ◽

Life Care ◽

Advanced Dementia ◽

Days Of Therapy

Background: Improving the use of antibiotics across the care continuum will be necessary as we strive to protect our patients from antimicrobial resistance. One potential target for antimicrobial stewardship is during end-of-life care of patients with advanced dementia. We aimed to perform a systematic literature review measuring the burden of antibiotic use during end-of-life care in patients with dementia. Methods: We searched PubMed, CINAHL, and Embase through July 2019 for studies with the following inclusion criteria in the initial analysis: (1) end-of-life patients (ie, dementia, cancer, organ failure, frailty or multi-morbidity); (2) antibiotic use in the end-of-life care; with the final analysis restricted to (3) patients with advanced dementia. Only randomized controlled trials (RCTs) and cohort studies were included. Results: Of the 93 full-text articles, 17 studies (18.3%) met the selection criteria for further analysis. Most of the included studies were retrospective (n = 8) or prospective (n = 8) cohort studies. These studies in combination included 2,501 patients with advanced dementia. Also, 5 studies (698 patients, [27.9%]) were restricted to patients with Alzheimer’s disease. In 5 studies in which data were available, fewer than one-quarter of patients (19.9%, 498) with advanced dementia were referred to palliative care. In 12 studies >50% of patients received antibiotics during the end-of-life period. Also, 15 studies did not report the duration of antimicrobial therapy. Only 2 studies reported the antimicrobial consumption in days of therapy per 1,000 resident days. Only 6 studies studied whether the use of antibiotics was associated with beneficial outcomes (survival or comfort), and none of them evaluated potential adverse effects associated with antibiotic use. Conclusions: There are significant gaps in the literature surrounding antimicrobial use at the end of life in patients with advanced dementia. Future studies are needed to evaluate the benefits and harms of using antibiotics for patients during end-of-life care in this patient population.Acknowledgement. We thank Jennifer Deberg from Hardin Library for the Health Sciences, University of Iowa Libraries on the search methods.Disclosures: NoneFunding: None

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Benefit and Harm of Extended Dual Antiplatelet Therapy After PCI in high-risk TWILIGHT-like patients with acute coronary syndrome

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.101 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

HY Wang ◽

R Zhang ◽

ZX Cai ◽

KF Dou

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Antiplatelet Therapy ◽

Cardiovascular Death ◽

Secondary Outcome ◽

Short Term ◽

Bleeding Events ◽

Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Recent emphasis on reduced duration and/or intensity of antiplatelet therapy following PCI irrespective of indication for PCI may fail to account for the substantial risk of subsequent nontarget lesion events in acute coronary syndrome (ACS) patients. This study sought to investigate the beneﬁts and risks of extended-term (>12-month) DAPT as compared with short-term DAPT in high-risk "TWILIGHT-like" ACS patients undergoing PCI. Methods All consecutive patients fulﬁlling the "TWILIGHT-like" criteria undergoing PCI from January 2013 to December 2013 were identiﬁed from the prospective Fuwai PCI Registry. High-risk "TWILIGHT-like" patients were deﬁned by at least 1 clinical and 1 angiographic feature based on TWILIGHT trial selection criteria. The present analysis evaluated 4,875 high-risk "TWILIGHT-like" patients with ACS who were event-free at 12 months after PCI. The primary outcome was the composite of all-cause death, myocardial infarction (MI), or stroke at 30 months while BARC type 2, 3, or 5 bleeding was key secondary outcome. Results Extended DAPT compared with shorter DAPT reduced the composite outcome of all-cause death, MI, or stroke by 63% (1.5% vs. 3.8%; HRadj: 0.374, 95% CI: 0.256 to 0.548; HRmatched: 0.361, 95% CI: 0.221-0.590). The HR for cardiovascular death was 0.049 (0.007 to 0.362) and that for MI 0.45 (0.153 to 1.320) and definite/probable stent thrombosis 0.296 (0.080-1.095) in propensity-matched analyses. Rates of BARC type 2, 3, or 5 bleeding (0.9% vs. 1.3%; HRadj: 0.668 [0.379 to 1.178]; HRmatched: 0.721 [0.369-1.410]) did not differ significantly in patients treated with DAPT > 12-month or DAPT ≤ 12-month. The effect of long-term DAPT on primary and key secondary outcome across the proportion of ACS patients with 1-3, 4-5, or 6-9 risk factors showed a consistent manner (Pinteraction > 0.05). Conclusion Among high-risk "TWILIGHT-like" patients with ACS after PCI, long-term DAPT reduced ischemic events without increasing clinically meaningful bleeding events as compared with short-term DAPT, suggesting that extended DAPT might be considered in the treatment of ACS patients who present with a particularly higher risk for thrombotic complications. Abstract Figure.

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Assessing the Feasibility of Retrospective Cohort Studies

American Journal of Industrial Medicine ◽

10.1002/ajim.4700120407 ◽

1987 ◽

Vol 12 (4) ◽

pp. 419-430 ◽

Cited By ~ 8

Author(s):

Kyle Steenland ◽

Leslie Stayner ◽

Alice Greife

Keyword(s):

Cohort Studies ◽

Retrospective Cohort ◽

Retrospective Cohort Studies

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A Systematic Review of Anticoagulation Strategies for Patients With Atrial Fibrillation in Critical Care.

Thrombosis and Haemostasis ◽

10.1055/a-1477-3760 ◽

2021 ◽

Author(s):

Alexandra Jayne Nelson ◽

Brian W Johnston ◽

Alicia Achiaa Charlotte Waite ◽

Gedeon Lemma ◽

Ingeborg Dorothea Welters

Keyword(s):

Atrial Fibrillation ◽

Critical Care ◽

Critically Ill ◽

Major Bleeding ◽

Critically Ill Patients ◽

Thromboembolic Events ◽

Bleeding Events ◽

Major Bleeding Events ◽

The Impact ◽

Anticoagulated Patients

Background. Atrial fibrillation (AF) is the most common cardiac arrhythmia in critically ill patients. There is a paucity of data assessing the impact of anticoagulation strategies on clinical outcomes for general critical care patients with AF. Our aim was to assess the existing literature to evaluate the effectiveness of anticoagulation strategies used in critical care for AF. Methodology. A systematic literature search was conducted using MEDLINE, EMBASE, CENTRAL and PubMed databases. Studies reporting anticoagulation strategies for AF in adults admitted to a general critical care setting were assessed for inclusion. Results. Four studies were selected for data extraction. A total of 44087 patients were identified with AF, of which 17.8-49.4% received anticoagulation. The reported incidence of thromboembolic events was 0-1.4% for anticoagulated patients, and 0-1.3% in non-anticoagulated patients. Major bleeding events were reported in three studies and occurred in 7.2-8.6% of the anticoagulated patients and up to 7.1% of the non-anticoagulated patients. Conclusions. There was an increased incidence of major bleeding events in anticoagulated patients with AF in critical care compared to non-anticoagulated patients. There was no significant difference in the incidence of reported thromboembolic events within studies, between patients who did and did not receive anticoagulation. However, the outcomes reported within studies were not standardised, therefore, the generalisability of our results to the general critical care population remains unclear. Further data is required to facilitate an evidence-based assessment of the risks and benefits of anticoagulation for critically ill patients with AF.

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Management of Oral Anticoagulation Therapy After Gastrointestinal Bleeding: Whether to, When to, and How to Restart an Anticoagulation Therapy

Annals of Pharmacotherapy ◽

10.1177/1060028017717019 ◽

2017 ◽

Vol 51 (11) ◽

pp. 1000-1007 ◽

Cited By ~ 9

Author(s):

Kazuhiko Kido ◽

Michael J. Scalese

Keyword(s):

Gastrointestinal Bleeding ◽

Cohort Studies ◽

Oral Anticoagulation ◽

Retrospective Cohort ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Cochrane Library ◽

Oral Anticoagulation Therapy ◽

Retrospective Cohort Studies

Objective: To evaluate current clinical evidence for management of oral anticoagulation therapy after gastrointestinal bleeding (GIB) with an emphasis on whether to, when to, and how to resume an anticoagulation therapy. Data Sources: Relevant articles from MEDLINE, Cochrane Library, and EMBASE databases were identified from 1946 through May 20, 2017, using the keywords: gastrointestinal hemorrhage or gastrointestinal bleeding and antithrombotic therapy or anticoagulation therapy or warfarin or dabigatran or rivaroxaban or apixaban or edoxaban.Study Selection and Data Extraction: All English-language studies assessing management of oral anticoagulation therapy after GIB were evaluated. Data Synthesis: A total of 9 studies were identified. Four retrospective cohort studies showed that resuming anticoagulation therapy was associated with significantly lower rate of thromboembolism (TE) in the general population. Meta-analyses and prospective cohort studies also supported this finding. Two retrospective cohort studies indicated an increase in GIB when anticoagulation reinitiation occurred in less than 7 days without a decrease in TE. Resuming therapy between 7 and 15 days did not demonstrate a significant increase in GIB or TE. A large retrospective study showed that apixaban was associated with the significantly lowest risk of GIB compared with both rivaroxaban and dabigatran. Conclusion: Anticoagulation therapy resumption is recommended, with resumption being considered between 7 and 14 days following GIB regardless of the therapy chosen. Data for warfarin management after GIB should be applied with caution to direct oral anticoagulants (DOACs) because of the quicker onset and experimental nature of reversal agents. Apixaban may be a preferred option when restarting a DOAC therapy.

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Abstract 15502: Clinical Outcomes in Patients Undergoing Non-cardiac Surgery Within 1 Year of Pci

Circulation ◽

10.1161/circ.142.suppl_3.15502 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Davide Cao ◽

Matthew A Levin ◽

Samantha Sartori ◽

Anastasios Roumeliotis ◽

Rishi Chandiramani ◽

...

Keyword(s):

Cardiac Surgery ◽

Antiplatelet Therapy ◽

Care Center ◽

Tertiary Care ◽

Coronary Intervention ◽

Secondary Outcome ◽

Cardiac Events ◽

Bleeding Events ◽

Target Vessel Revascularization ◽

Increased Risk

Introduction: Perioperative cardiovascular events are an important cause of morbidity and mortality associated with non-cardiac surgery (NCS), especially in patients with recent percutaneous coronary intervention (PCI) who require dual antiplatelet therapy. Objective: To illustrate the types and timing of different noncardiac surgeries occurring within 1 year of PCI, and to evaluate the risk of thrombotic and bleeding events according to perioperative antiplatelet management. Methods: All patients undergoing NCS within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, stent thrombosis or target vessel revascularization). The key secondary outcome was major bleeding, defined as ≥2 units of blood transfusion. All outcomes were evaluated at 30 days after NCS. Results: A total of 1092 NCS (corresponding to 747 patients) were included and classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones ( Figure-A ). The incidence of MACE and bleeding was time-dependent, with an increased risk in surgeries occurring in the first 6 months post-PCI ( Figure-B ). Perioperative antiplatelet cessation occurred in 487 (44.6%) NCS and was more likely for intermediate-risk procedures and after 6 months of PCI. There was no significant association between antiplatelet cessation and cardiac events. Conclusions: Among patients undergoing NCS within 1 year of PCI, the perioperative risk of MACE is inversely related to time from PCI. Preoperative interruption of antiplatelet therapy was observed in less than half of all cases and was not associated with an increased risk of cardiac events.

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