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Perioperative outcomes of interrupted anticoagulation in patients with non-valvular atrial fibrillation undergoing non-cardiac surgery

Yeungnam University Journal of Medicine 2020년 37권 4호 p.321 ~ 328
박보은, 배명환, 김완욱, 박윤정, 김홍년, 장세용, 이장훈, 양동헌, 박훈식, 조용근, 채성철,
소속 상세정보
박보은 ( Park Bo-Eun ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Internal Medicine
배명환 ( Bae Myung-Hwan ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Internal Medicine
김완욱 ( Kim Wan-Wook ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Internal Medicine
박윤정 ( Park Yoon-Jung ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Internal Medicine
김홍년 ( Kim Hong-Nyun ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Internal Medicine
장세용 ( Jang Se-Yong ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Internal Medicine
이장훈 ( Lee Jang-Hoon ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Internal Medicine
양동헌 ( Yang Dong-Heon ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Internal Medicine
박훈식 ( Park Hun-Sik ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Internal Medicine
조용근 ( Cho Yong-Keun ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Internal Medicine
채성철 ( Chae Shung-Chull ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Internal Medicine

Abstract


Background: This study aimed to investigate the incidences of and risk factors for perioperative events following anticoagulant discontinuation in patients with non-valvular atrial fibrillation (NVAF) undergoing non-cardiac surgery.

Methods: A total of 216 consecutive patients who underwent cardiac consultation for suspending perioperative anticoagulants were enrolled. A perioperative event was defined as a composite of thromboembolism and major bleeding.

Results: The mean anticoagulant discontinuation duration was 5.7 (±4.2) days and was significantly longer in the warfarin group (p<0.001). Four perioperative thromboembolic (1.9%; three strokes and one systemic embolization) and three major bleeding events (1.4%) were observed. The high CHA2DS2-VASc and HAS-BLED scores and a prolonged preoperative anticoagulant discontinuation duration (4.4±2.1 vs. 2.9±1.8 days; p=0.028) were associated with perioperative events, whereas the anticoagulant type (non-vitamin K antagonist oral anticoagulants or warfarin) was not. The best cut-off levels of the HAS-BLED and CHA2DS2-VASc scores were 3.5 and 2.5, respectively, and the preoperative anticoagulant discontinuation duration for predicting perioperative events was 2.5 days. Significant differences in the perioperative event rates were observed among the four risk groups categorized according to the sum of these values: risk 0, 0%; risk 1, 0%; risk 2, 5.9%; and risk 3, 50.0% (p<0.001). Multivariate logistic regression analysis showed that the HAS-BLED score was an independent predictor for perioperative events.

Conclusion: Thromboembolic events and major bleeding are not uncommon during perioperative anticoagulant discontinuation in patients with NVAF, and interrupted anticoagulation strategies are needed to minimize these.

키워드

Anticoagulants; Atrial fibrillation; Perioperative period; Surgery; Thromboembolism

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