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Outcomes of patients on dual antiplatelet therapy post‐coronary stenting following emergency noncardiac surgery
Author(s) -
Irie Hiromasa,
Kawai Keiko,
Otake Takanao,
Shinjo Yasutaka,
Kuriyama Akira,
Yamashita Shigeki
Publication year - 2019
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13377
Subject(s) - medicine , aspirin , retrospective cohort study , surgery , coronary stenting , hazard ratio , stent , complication , acute coronary syndrome , platelet aggregation inhibitor , emergency surgery , myocardial infarction , restenosis , confidence interval
Background The outcomes of patients on dual antiplatelet therapy (DAPT) post‐coronary stenting following emergency noncardiac surgery remain unclear. Methods This retrospective cohort study included patients on DAPT post‐coronary stenting who underwent emergency noncardiac surgery within 24 hours of diagnosis from April 2007 to March 2018 where DAPT was discontinued within <5 days for aspirin and 7 days for P2Y 12 inhibitors. Our primary outcome was 180‐day mortality in these patients. We investigated factors associated with bleeding within 180 days after surgery as our secondary outcome and exploratorily examined factors affecting 180‐day mortality. Results Of 62,528 patients who underwent any surgery under general anaesthesia during the 11‐year study period, 133 patients (0.22% of all and 1.41% of emergency surgical patients) were analysed. Among the eligible patients, 180‐day mortality was 9.8% (13/133). Eighteen patients (13.5%) developed bleeding within 180 days after surgery, which was the most common post‐operative complication. Restarting antiplatelet agents <2 days post‐operatively (OR, 4.51; 95% CI, 1.56‐13.0; P = 0.005) and stent implantation at bifurcation lesions before surgery (OR, 3.28; 95% CI, 1.07‐10.1; P = 0.04) were associated with post‐operative bleeding. Patients on haemodialysis had the worse prognosis (hazard ratio, 5.73; 95% CI, 1.87‐17.5; P = 0.002) in terms of 180‐day mortality. Conclusion The 180‐day mortality following emergency noncardiac surgery was approximately 10% in patients on DAPT post‐coronary stenting. Restarting antiplatelet agents earlier than 2 days post‐operatively and coronary stenting at bifurcation lesions were associated with bleeding within 180 days after surgery.