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중등도 이상의 위험 수술을 받은 환자에서 수술 전후 항혈전제 약물 사용 평가

Title
중등도 이상의 위험 수술을 받은 환자에서 수술 전후 항혈전제 약물 사용 평가
Other Titles
Evaluation of Perioperative Antithrombotic Management in Patients Undergoing Moderate to High Risk Surgery
Author
이주연
Keywords
Antiplatelets; anticoagulants; surgery; bridging therapy
Issue Date
2017-03
Publisher
한국임상약학회
Citation
한국임상약학회지, v. 27, No. 1, Page. 15-21
Abstract
Objective: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between the risk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in real world setting. Methods: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010 to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzed the timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate of thromboembolic event and major hemorrhage were also investigated. Results: A total of 329 patients were included. The concordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patients undergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2% and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant before surgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleeding and thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for major bleeding (adjusted OR 2.65. 95% CI 1.33-5.28). Conclusion: The concordance rate with guideline regarding perioperative antithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.
URI
https://www.earticle.net/Article/A300860http://repository.hanyang.ac.kr/handle/20.500.11754/103166
ISSN
1226-6051
Appears in Collections:
COLLEGE OF PHARMACY[E](약학대학) > PHARMACY(약학과) > Articles
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