Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Features of Thromboembolic and Hemorrhagic Complications in Planned Surgical Interventions in Patients with Atrial Fibrillation

https://doi.org/10.20996/1819-6446-2019-15-3-315-321

Full Text:

Abstract

Aim. To study the frequency and characteristics of the development of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF) during planned surgical interventions.
Material and methods. Preoperative examination and postoperative observation of 214 patients with AF (139 men and 75 women) who received anticoagulant therapy (ACT) and underwent planned surgery was carried out. The consistency of the used perioperative ACT regimens when performing interventions with current international recommendations was analyzed.
Results. Complications developed in 33 patients (15.4%) from the total sample of 214 patients: in 14 (6.5%) thromboembolism, in 19 (8.9%) hemorrhagic complications. Analysis of the complication frequency in various types of surgical interventions showed that the frequency of thromboembolism during heart and vascular operations was 9.8% (4 cases), with interventions for malignant tumors – 7 (6.2%), while performing general surgical abdominal tumors operations – 3 (5.0%). The frequency of bleeding was maximum during operations for cancer 18.6%, this value was significantly higher compared with the frequency of these complications when performing general surgical abdominal operations – 3 cases (5.0%), and during interventions on the heart and vascular vessels bleedings were not observed. The total frequency of complications was also maximal when performing interventions for malignant tumors – 24.8%. This value was significantly higher than in the groups of patients who underwent general surgical abdominal operations – 10.0%, and interventions on the heart and vessels – 9.8%. Analysis of the frequency of compliance with the recommendations of the European Society of Cardiology in terms of ACT usage in patients with AF in the perioperative period and the structure of errors in choosing the ACT regimen showed that among the examined patients the recommendations were followed only in 102 (47.7%), while the frequency of non-recommended regimens use reached 52.3% (112 patients). The most frequently incorrectly used scheme was “bridge therapy” with the possibility of canceling oral anticoagulants in 107 (50.0%) patients.
Conclusion. A significantly higher frequency of complications was found in patients, whose management did not follow the recommendations for perioperative ACT.

About the Authors

L. N. Uddin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

MD, Post-Graduate Student, Chair of Faculty Therapy №1

Trubetskaya ul. 8-2, Moscow, 119991 Russia



A. V. Egorov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

MD, PhD, Professor, Chair of Faculty Surgery №1; Head of Surgical Abdominal Department, University Clinical Hospital №1

Trubetskaya ul. 8-2, Moscow, 119991 Russia



A. A. Sokolova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

MD, PhD, Assistant, Chair of Faculty Therapy №1

Trubetskaya ul. 8-2, Moscow, 119991 Russia



N. S. Morozova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

MD, PhD, Associate Professor, Chair of Faculty Therapy №1

Trubetskaya ul. 8-2, Moscow, 119991 Russia



D. A. Napalkov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

MD, PhD, Professor, Chair of Faculty Therapy №1

Trubetskaya ul. 8-2, Moscow, 119991 Russia



V. V. Fomin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Head of Chair of Faculty Therapy №1

Trubetskaya ul. 8-2, Moscow, 119991 Russia



References

1. Kovacs R.J., Flaker G.C., Saxonhouse S.J. et al. Practical management of anticoagulation in patients with atrial fibrillation. J Am Coll Cardiol. 2015;65:1340-60. DOI:10.1016/j.jacc.2015.01.049.

2. Youness H.A., Keddissi J., Berim I., Awab A. Management of oral antiplatelet agents and anticoagulation therapy before bronchoscopy. J Thorac Dis. 2017;9(Suppl 10):1022-33. DOI:10.21037/jtd.2017.05.45.

3. Belenkov Y.N., Shakariants G.A., Khabarova N.V., An G.V. Anticoagulant therapy in elderly patients with atrial fibrillation. Kardiologiia. 2018;58(10):45-52 (In Russ.) DOI: 10.18087/cardio.2018.10.10177.

4. Hellman T., Kiviniemi T., Nuotio I., et al. Intensity of anticoagulation and risk of thromboembolism after elective cardioversion of atrial fibrillation. Thromb Res. 2017;156:163-7. DOI:10.1016/J.THROMRES.2017.06.026.

5. Lin Y.S., Chen Y.L., Chen T.H., et al. Comparison of Clinical Outcomes Among Patients With Atrial Fibrillation or Atrial Flutter Stratified by CHA2DS2-VASc Score. JAMA Netw Open. 2018;1(4):e180941. DOI:10.1001/jamanetworkopen.2018.0941.

6. Ostroumova O.D., Voevodina N.Iu., Guseva T.F. et al. Prevention of stroke in patients with atrial fibrillation and concomitant diseases. Systemic hypertension. 2018;15(2):55-9 (In Russ.) DOI: 10.26442/2075-082X_2018.2.55-59.

7. Bower M.M., Sweidan A.J., Shafie M. et al. Contemporary Reversal of Oral Anticoagulation in Intracerebral Hemorrhage. Stroke. 2019;50(2):529-36. DOI:10.1161/STROKEAHA.118.023840.

8. Tafur A.J., McBane R. 2nd, Wysokinski W.E., et al. Predictors of major bleeding in peri-procedural anticoagulation management. J Thromb Haemost. 2012;10(2):261-7. DOI:10.1111/j.1538-7836.2011.04572.x.

9. Wysokinski W.E., McBane R.D. II. Periprocedural bridging management of anticoagulation. Circulation. 2012;126(4):486-90. DOI:10.1161/CIRCULATIONAHA.112.092833.

10. Steffel J., Verhamme P., Potpara T.S., et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J. 2018;00:1-64. DOI:10.1093/eurheartj/ehy136.

11. Kirchhof P., Benussi S., Kotecha D., et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962. DOI:10.1093/eurheartj/ehw210.

12. Chao T.F., Liu C.J., Wang K.L., et al. Using the CHA2DS2-VASc score for refining stroke risk stratification in ’low-risk’ Asian patients with atrial fibrillation. J Am Coll Cardiol. 2014;64(16):1658-65. DOI:10.1016/j.jacc.2014.06.1203.

13. Altiok E., Marx N. Oral Anticoagulation. Dtsch Arztebl Int. 2018;115(46):776-83. DOI:10.3238/arztebl.2018.0776.

14. Kannan A., Poongkunran C., Shenoy S., Abidov A. Perioperative Management of Anticoagulation-Review of Latest Evidence. Am J Ther. 2016;23(2):474-84. DOI:10.1097/MJT.0000000000000121.

15. Sturov N.V., Velichko E.V. Patients receiving long-term oral anticoagulants: bridge therapy for certain types of surgical operations and invasive procedures. Trudnyiy Patsient. 2014;12(5):46-50. (In Russ.).

16. Douketis J.D., Healey J.S., Brueckmann M., et al. Perioperative bridging anticoagulation during dabigatran or warfarin interruption among patients who had an elective surgery or procedure. Substudy of the RE-LY trial. Thromb Haemost. 2015;113(3):625-32. DOI:10.1160/TH14-04-0305.

17. Clark N.P., Witt D.M., Davies L.E., et al. Bleeding, recurrent venous thromboembolism, and mortality risks during warfarin interruption for invasive procedures. JAMA Intern Med. 2015;175(7):1163-8. DOI:10.1001/jamainternmed.2015.1843.

18. Ono K., Hidaka H., Koyama Y., et al. Effects of heparin bridging anticoagulation on perioperative bleeding and thromboembolic risks in patients undergoing abdominal malignancy surgery. J Anesth. 2016;30(4):723-6. DOI:10.1007/s00540-016-2187-0.

19. Myat Moe M.M., Redla S. Incidental pulmonary embolism in oncology patients with current macroscopic malignancy: incidence in different tumor type and impact of delayed treatment on survival outcome. Br J Radiol. 2018:20170806. DOI:10.1259/bjr.20170806.


For citation:


Uddin L.N., Egorov A.V., Sokolova A.A., Morozova N.S., Napalkov D.A., Fomin V.V. Features of Thromboembolic and Hemorrhagic Complications in Planned Surgical Interventions in Patients with Atrial Fibrillation. Rational Pharmacotherapy in Cardiology. 2019;15(3):315-321. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-3-315-321

Views: 130


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)