Article of the Month – October 2019

Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery

URL: https://bjanaesthesia.org/article/S0007-0912(18)30809-2/fulltext

DOI: https://doi.org/10.1016/j.bja.2018.09.029

Published: BJA. Published online on December 15, 2018.

Authors: S.J. Howell, S.E. Hoeks, R.M. West, S.B. Wheatcroft, A. Hoeft for the OBTAIN group of investigators of European Society of Anaesthesiology – Clinical Trial Network.

Article Description:

  • Occurrence of Bleeding and Thrombosis during Antiplatelet Therapy In Non-Cardiac Surgery (OBTAIN) studied the association of perioperative antiplatelet therapy with perioperative Major Adverse Cardiac Events (MACE) and major bleeding after non-cardiac surgery.
  • OBTAIN investigators included 847 patients in that prospective observational multicentre cohort study.

Summary:

  • Perioperative antiplatelet therapy in patients with recent percutaneous coronary intervention (PCI) is still a controversial issue. After PCI, patients undergo dual antiplatelet therapy (DAPT) until epithelisation of the stents to reduce the risk of stent thrombosis. Time of epithelisation differs according to the type of the used stent.
  • Continuation of the DAPT during non-cardiac surgery carries the risk of major bleeding.
  • Therefore, OBTAIN group carried out this study to investigate the incidence of MACE and major bleeding in the perioperative period with DAPT, single antiplatelet or without antiplatelet therapy.
  • In a propensity matched analysis of 177 patients who received DAPT and 177 monotherapy patients, the risk ratio for MACE with DAPT was 1.83 (0.69e4.85), P¼0.32. The risk of bleeding was significantly greater in the DAPT group 4.00 (1.15e13.93), P¼0.031.
  • OBTAIN showed increased risks of bleeding with perioperative DAPT without clear evidence of their protective role against MACE; however, this is still an arguable issue.

Check this interesting study and look for the results: would this be a plus or change your practice? 

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