[择期手术的心房颤动患者血栓栓塞和出血事件的预防]

[Prevention of thromboembolic and hemorrhagic events in patients with atrial fibrillation undergoing elective surgery].

作者信息

Uddin L N, Sokolova A A, Egorov A V, Napalkov D A, Fomin V V, Vychuzhanin D V, Dzyundzya A N, Abdulkhakimov N M, Trifonova A A

机构信息

Sechenov First Moscow State Medical University Ministry of Health of Russia, Moscow, Russia.

出版信息

Khirurgiia (Mosk). 2019(7):52-57. doi: 10.17116/hirurgia201907152.

DOI:10.17116/hirurgia201907152

PMID:31355815

Abstract

OBJECTIVE

To compare incidence of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF) undergoing elective surgery on different schemes of perioperative anticoagulant therapy (ACT).

MATERIAL AND METHODS

There were 86 patients (56 (65.1%) men and 30 (34.9%) women, mean age was 69 (64; 78) years) with non-valvular AF who underwent elective interventions. Forty (46.5%) patients underwent abdominal surgery, 34 (39.5%) - cardiovascular procedures, 12 (14.0%) patients underwent surgery for malignant diseases. We have analyzed incidence of thromboembolic and hemorrhagic events and compliance of perioperative ACT modes with current international guidelines.

RESULTS

Thromboembolic and hemorrhagic events developed in 14 (16.3%) patients. Thromboembolic complications were noted in 6 (7.0%) patients, hemorrhagic events - in 8 (9.3%) cases. Maximum complication rate was observed in case of bridge-therapy (n=12, 20.0%). Cancellation of ACT was followed by 2 (9.5%) complications, bridge-therapy - by 4 (6.7%) thromboembolic complications. Hemorrhagic events were 2 times more common in case of this therapy (n=8, 13.3%). It was found that ESC guidelines for perioperative ACT were applied in less than half of patients (41, 47.7% patients with AF undergoing elective surgery). Half of complications (8 out of 16) occurred if unapproved modes of ACT were used (including 7 cases of bridge-therapy was not necessary). The causes of these complications were inadequate assessment of perioperative risk of thromboembolic and hemorrhagic events; unreasonable administration of bridge therapy.

CONCLUSION

An unambiguous clinical effect of bridge therapy has not been confirmed in patients with high risk of thromboembolic complications. Cancer patients have higher risk of complications compared with others. These events occur mainly due to non-compliance with clinical guidelines and insufficient prevention of thromboembolic events.

摘要

目的

比较接受择期手术的心房颤动（AF）患者在不同围手术期抗凝治疗（ACT）方案下血栓栓塞和出血并发症的发生率。

材料与方法

86例非瓣膜性AF患者（56例（65.1%）男性，30例（34.9%）女性，平均年龄69（64；78）岁）接受择期干预。40例（46.5%）患者接受腹部手术，34例（39.5%）接受心血管手术，12例（14.0%）患者接受恶性疾病手术。我们分析了血栓栓塞和出血事件的发生率以及围手术期ACT模式与当前国际指南的符合情况。

结果

14例（16.3%）患者发生血栓栓塞和出血事件。6例（7.0%）患者出现血栓栓塞并发症，8例（9.3%）出现出血事件。桥接治疗时并发症发生率最高（n = 12，20.0%）。停用ACT后出现2例（9.5%）并发症，桥接治疗出现4例（6.7%）血栓栓塞并发症。该治疗方式下出血事件更为常见（n = 8，13.3%），是其2倍。发现不到一半的患者（41例，47.7%接受择期手术的AF患者）应用了ESC围手术期ACT指南。如果使用未经批准的ACT模式（包括7例不必要的桥接治疗），则一半的并发症（16例中的8例）会发生。这些并发症的原因是对围手术期血栓栓塞和出血事件风险评估不足；桥接治疗的不合理应用。