[Prevention of thromboembolic and hemorrhagic events in patients with atrial fibrillation undergoing elective surgery].

Autor:	Uddin LN; Sechenov First Moscow State Medical University Ministry of Health of Russia, Moscow, Russia., Sokolova AA; Sechenov First Moscow State Medical University Ministry of Health of Russia, Moscow, Russia., Egorov AV; Sechenov First Moscow State Medical University Ministry of Health of Russia, Moscow, Russia., Napalkov DA; Sechenov First Moscow State Medical University Ministry of Health of Russia, Moscow, Russia., Fomin VV; Sechenov First Moscow State Medical University Ministry of Health of Russia, Moscow, Russia., Vychuzhanin DV; Sechenov First Moscow State Medical University Ministry of Health of Russia, Moscow, Russia., Dzyundzya AN; Sechenov First Moscow State Medical University Ministry of Health of Russia, Moscow, Russia., Abdulkhakimov NM; Sechenov First Moscow State Medical University Ministry of Health of Russia, Moscow, Russia., Trifonova AA; Sechenov First Moscow State Medical University Ministry of Health of Russia, Moscow, Russia.
Jazyk:	ruština
Zdroj:	Khirurgiia [Khirurgiia (Mosk)] 2019 (7), pp. 52-57.
DOI:	10.17116/hirurgia201907152
Abstrakt:	Objective: To compare incidence of thromboembolic and hemorrhagic complications in patients with atrial fibrillation (AF) undergoing elective surgery on different schemes of perioperative anticoagulant therapy (ACT). Material and Methods: There were 86 patients (56 (65.1%) men and 30 (34.9%) women, mean age was 69 (64; 78) years) with non-valvular AF who underwent elective interventions. Forty (46.5%) patients underwent abdominal surgery, 34 (39.5%) - cardiovascular procedures, 12 (14.0%) patients underwent surgery for malignant diseases. We have analyzed incidence of thromboembolic and hemorrhagic events and compliance of perioperative ACT modes with current international guidelines. Results: Thromboembolic and hemorrhagic events developed in 14 (16.3%) patients. Thromboembolic complications were noted in 6 (7.0%) patients, hemorrhagic events - in 8 (9.3%) cases. Maximum complication rate was observed in case of bridge-therapy (n=12, 20.0%). Cancellation of ACT was followed by 2 (9.5%) complications, bridge-therapy - by 4 (6.7%) thromboembolic complications. Hemorrhagic events were 2 times more common in case of this therapy (n=8, 13.3%). It was found that ESC guidelines for perioperative ACT were applied in less than half of patients (41, 47.7% patients with AF undergoing elective surgery). Half of complications (8 out of 16) occurred if unapproved modes of ACT were used (including 7 cases of bridge-therapy was not necessary). The causes of these complications were inadequate assessment of perioperative risk of thromboembolic and hemorrhagic events; unreasonable administration of bridge therapy. Conclusion: An unambiguous clinical effect of bridge therapy has not been confirmed in patients with high risk of thromboembolic complications. Cancer patients have higher risk of complications compared with others. These events occur mainly due to non-compliance with clinical guidelines and insufficient prevention of thromboembolic events.
Databáze:	MEDLINE
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