McGill University Health Centre, Montreal, Quebec, Canada; Hôpital Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
McGill University Health Centre, Montreal, Quebec, Canada.
Int J Cardiol. 2019 Aug 1;288:87-93. doi: 10.1016/j.ijcard.2019.04.066. Epub 2019 Apr 26.
Anti-platelet therapy is commonly used in patients receiving oral anticoagulation and may increase bleeding risk among patients undergoing cardiac implantable electronic device (CIED) surgery. We sought to determine the proportion of anticoagulated patients who are concomitantly receiving anti-platelet therapy, the associated risk of clinically significant hematoma (CSH), and the proportion of patients in whom anti-platelet usage is guideline-indicated.
A secondary analysis of the Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial (BRUISE CONTROL). Patients who were receiving warfarin, had an annual predicted risk of thromboembolism of ≥5% and were scheduled to undergo non-emergent CIED surgery were randomized to continued warfarin versus heparin bridging. In the current analysis, patients were divided into those receiving anti-platelet therapy and those not receiving anti-platelet therapy. The incidence of CSH was compared in both groups. The proportion of patients on potentially inappropriate and potentially interruptible antiplatelet therapy was estimated.
All 681 patients enrolled in BRUISE CONTROL were included, of whom 280 received and 401 did not receive anti-platelet therapy. Anti-platelet therapy increased the risk of CSH (relative risk, 1.72; 95% confidence interval (CI), 1.09 to 2.72; P = 0.02). Of the 280 patients receiving anti-platelet therapy, 97 (34.6%) had no guideline indication for concomitant anti-platelet therapy and an additional 146 (52.1%) were on anti-platelet therapy that could potentially have been interrupted around CIED surgery.
Concomitant anti-platelet therapy in patients receiving anticoagulation is associated with a significant risk of CSH. The majority of concomitant anti-platelet therapy is potentially inappropriate or interruptible.
clinicaltrials.gov Identifier: (NCT00800137).
抗血小板治疗常用于接受口服抗凝治疗的患者，可能会增加接受心脏植入式电子设备 (CIED) 手术的患者出血风险。我们旨在确定同时接受抗血小板治疗的抗凝患者比例、临床显著血肿 (CSH) 的相关风险以及指南建议使用抗血小板治疗的患者比例。
桥接或继续华法林用于装置手术随机对照试验 (BRUISE CONTROL) 的二次分析。正在服用华法林、年血栓栓塞风险≥5%且计划进行非紧急 CIED 手术的患者随机分配至继续华法林或肝素桥接治疗。在当前分析中，患者被分为接受抗血小板治疗和不接受抗血小板治疗的两组。比较两组患者 CSH 的发生率。估计了潜在不适当和潜在可中断抗血小板治疗的患者比例。
BRUISE CONTROL 共纳入 681 例患者，其中 280 例接受抗血小板治疗，401 例未接受抗血小板治疗。抗血小板治疗增加了 CSH 的风险（相对风险，1.72；95%置信区间 (CI)，1.09 至 2.72；P=0.02）。在接受抗血小板治疗的 280 例患者中，97 例（34.6%）无同时接受抗血小板治疗的指南指征，另有 146 例（52.1%）接受的抗血小板治疗在 CIED 手术前后可能中断。
接受抗凝治疗的患者同时接受抗血小板治疗与 CSH 显著风险相关。大多数同时接受的抗血小板治疗可能不适当或可中断。
clinicaltrials.gov 标识符：（NCT00800137）。
