Mima Yohei, Yasaka Masahiro, Wakugawa Yoshiyuki, Okada Yasushi
Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan.
Intern Med. 2015;54(17):2115-20. doi: 10.2169/internalmedicine.54.4071. Epub 2015 Sep 1.
Intravascular catheter procedures are often performed in patients undergoing antithrombotic therapy. However, methods for the management of antithrombotic agents in the perioperative period are currently unclear. Therefore, the safety and management of antithrombotic agents in these patients were investigated.
A prospective, multicenter, observational study [Management of Antithrombotic Agents During Surgery or Medical Procedures with Bleeding (MARK study)] at 58 National Hospital Organization institutions in Japan was performed. 1,040 patients were enrolled in the MARK study and underwent an intravascular catheter procedure. For all participants, the details of the procedure, method of perioperative management of antithrombotic agents, and occurrence of thrombosis, embolism, and bleeding complications during the study period were investigated.
The use of antithrombotic agents was continued in 1,017 patients (98%, continuation group) and discontinued in the other 23 (2%, discontinuation group). Continuation of the antithrombotic agents did not have a significant effect on the overall occurrence of thromboembolism [hazard ratio (HR), 0.15; p=0.08] or bleeding events (HR, 0.19; p=0.12). However, the overall adverse event risk was significantly lower in the continuation group than in the discontinuation group (HR, 0.18; p=0.03).
It is both safe and appropriate to perform intravascular catheter procedures in patients continuing with antithrombotic therapy.
血管内导管操作常在接受抗血栓治疗的患者中进行。然而，围手术期抗血栓药物的管理方法目前尚不清楚。因此，对这些患者抗血栓药物的安全性及管理进行了研究。
在日本58家国立医院组织的机构中开展了一项前瞻性、多中心、观察性研究[手术或医疗操作期间抗血栓药物的管理（MARK研究）]。1040例患者纳入MARK研究并接受了血管内导管操作。对所有参与者，调查了操作细节、抗血栓药物围手术期管理方法以及研究期间血栓形成、栓塞和出血并发症的发生情况。
1017例患者（98%，继续用药组）继续使用抗血栓药物，另外23例（2%，停药组）停药。继续使用抗血栓药物对血栓栓塞的总体发生率[风险比（HR），0.15；p=0.08]或出血事件（HR，0.19；p=0.12）没有显著影响。然而，继续用药组的总体不良事件风险显著低于停药组（HR，0.18；p=0.03）。
在继续接受抗血栓治疗的患者中进行血管内导管操作既安全又合适。
