Department of General, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, 97080, VisceralWürzburg, Germany.
Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital of Würzburg, Würzburg, Germany.
BMC Anesthesiol. 2023 Feb 16;23(1):56. doi: 10.1186/s12871-023-02017-z.
Perioperative bridging of oral anticoagulation increases the risk of bleeding complications after elective general and visceral surgery. The aim of this study was to explore, whether an individual risk-adjusted bridging regimen can reduce bleeding events, while still protecting against thromboembolic events.
We performed a quality improvement study comparing bridging parameters and postoperative outcomes before (period 1) and after implementation (period 2) of a new risk-adjusted bridging regimen. The primary endpoint of the study was overall incidence of postoperative bleeding complications during 30 days postoperatively. Secondary endpoints were major postoperative bleeding, minor bleeding, thromboembolic events, postoperative red blood cell transfusion, perioperative length-of-stay (LOS) and in-hospital mortality.
A total of 263 patients during period 1 and 271 patients during period 2 were compared. The included elective operations covered the entire field of general and visceral surgery. The overall incidence of bleeding complications declined from 22.1% during period 1 to 10.3% in period 2 (p < 0.001). This reduction affected both major as well as minor bleeding events (8.4% vs. 4.1%; p = 0.039; 13.7% vs. 6.3%; p = 0.004). The incidence of thromboembolic events remained low (0.8% vs. 1.1%). No changes in mortality or length-of-stay were observed.
It is important to balance the individual thromboembolic and bleeding risks in perioperative bridging management. The risk adjusted bridging regimen reduces bleeding events in general and visceral surgery while the risk of thromboembolism remains comparably low.
择期普通外科和内脏手术围手术期桥接抗凝会增加出血并发症的风险。本研究旨在探讨个体化风险调整桥接方案是否可以降低出血事件发生率，同时仍能预防血栓栓塞事件。
我们进行了一项质量改进研究，比较了新的个体化风险调整桥接方案实施前后（第 1 期和第 2 期）的桥接参数和术后结果。研究的主要终点是术后 30 天内总的术后出血并发症发生率。次要终点是主要术后出血、轻微出血、血栓栓塞事件、术后红细胞输血、围手术期住院时间（LOS）和院内死亡率。
第 1 期纳入 263 例患者，第 2 期纳入 271 例患者。纳入的择期手术涵盖普通外科和内脏外科的各个领域。出血并发症的总发生率从第 1 期的 22.1%下降到第 2 期的 10.3%（p<0.001）。这种降低影响了主要和轻微出血事件（8.4%比 4.1%；p=0.039；13.7%比 6.3%；p=0.004）。血栓栓塞事件的发生率仍然较低（0.8%比 1.1%）。死亡率或住院时间无变化。
在围手术期桥接管理中平衡个体的血栓栓塞和出血风险非常重要。风险调整桥接方案可降低普通外科和内脏外科的出血事件发生率，而血栓栓塞风险仍保持较低水平。
