Three-month cumulative incidence of thromboembolism and bleeding after periprocedural anticoagulation management of arterial vascular bypass patients.
Three-month cumulative incidence of thromboembolism and bleeding after periprocedural anticoagulation management of arterial vascular bypass patients.
复制标题
动脉血管搭桥患者围手术期抗凝治疗后三个月血栓栓塞和出血的累积发生率。
DOI：
10.1007/s11239-012-0787-6
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发表时间：
2013
影响因子：
4
通讯作者：
McBane2nd,RobertD
中科院分区：
文献类型：
--
作者：
Attaya,Hosam;Wysokinski,WaldemarE;Bower,Thomas;Litin,Scott;Daniels,PaulR;Slusser,Joshua;Heit,JohnA;McBane2nd,RobertD
本研究的目的是确定长期抗凝血管旁路移植术 (BG) 患者因侵入性手术需要暂时中断华法林的围手术期血栓栓塞 (TE) 的 3 个月累积发生率，包括移植物闭塞和围手术期出血。对接受长期华法林治疗的患者进行适当的围手术期管理以保持下肢动脉 BG 通畅尚不清楚。在一项方案驱动的队列研究设计中，所有 BG 患者均转至 Mayo Clinic 血栓形成倾向中心进行围手术期抗凝治疗（1997-2007 年），并及时进行随访，以估计 TE 和出血的 3 个月累积发生率。根据估计的 TE 和出血风险，个体化地决定提供“桥接”低分子量肝素 (LMWH)。共有 78 名 BG 患者（69 ± 10 岁；38% 女性），其中 73% 有远端自体 BG，53% 有假体 BG； 45% 接受了抗血小板治疗。 77% 的患者接受了围手术期 LMWH，并且不因 BG 远端吻合位置或类型而异。 TE 的 3 个月累积发生率为 5.1%（95% CI 1.4-12.6），包括 2 次 BG 闭塞、1 次 DVT 和 1 次心肌梗死。 1 名患者发生大出血（1.28%，95% CI 0.0–6.94）。一名患者因心力衰竭死亡。 TE 和出血没有因桥接状态而异。因侵入性操作而暂时中断华法林的 BG 患者 3 个月累积 TE 发生率可能高于其他“桥接”人群（房颤、人工心脏瓣膜、静脉血栓栓塞）。这一发现强调了远端旁路移植物通常脆弱的性质，需要采取积极的围手术期抗凝管理方法。
The objective of this study was to determine 3-month cumulative incidence of peri-procedural thromboembolism (TE) including graft occlusion, and peri-procedural bleeding for chronically anticoagulated vascular bypass graft (BG) patients requiring temporary warfarin interruption for an invasive procedure. Appropriate peri-procedural management of patients receiving chronic warfarin therapy to preserve lower extremity arterial BG patency is unknown. In a protocol driven, cohort study design, all BG patients referred to the Mayo Clinic Thrombophilia Center for peri-procedural anticoagulation (1997–2007) were followed forward in time to estimate the 3-month cumulative incidence of TE and bleeding. Decisions to provide “bridging” low molecular weight heparin (LMWH) were individualized based on estimated risk of TE and bleeding. There were 78 BG patients (69 ± 10 years; 38 % women), of whom 73 % had a distal autogenous and 53 % had prosthetic BG; 45 % received antiplatelet therapy. Peri-procedural LMWH was prescribed for 77 % of patients and did not vary by BG distal anastomosis location or type. The 3-month cumulative incidence of TE was 5.1 % (95 % CI 1.4–12.6), including two BG occlusions, one DVT, and one myocardial infarction. Major bleeding occurred in 1 patient (1.28 %, 95 % CI 0.0–6.94). One patient died due to heart failure. TE and bleeding did not differ by bridging status. The 3-month cumulative incidence of TE among BG patients in whom warfarin is temporarily interrupted for an invasive procedure may be higher than in other “bridging” populations (atrial fibrillation, prosthetic heart valve, venous thromboembolism). This finding underscores the often tenuous nature of distal bypass grafts necessitating an aggressive approach to peri-procedural anticoagulation management.