RISKS AND PREDICTORS OF ISCHEMIC/BLEEDING COMPLICATIONS IN CARDIAC PATIENTS UNDERGOING ELECTIVE NON-CARDIAC SURGERY – AN ANALYSIS OF THE PRAGUE-14 STUDY

Objective. To assess risks and predictors of ischemic/bleeding complications in consecutive patients with at least one cardiovascular disease undergoing elective major non-cardiac surgery. Methods. This prospective study analyzed the impact of antithrombotic therapy interruption on outcomes in non-selected surgical patients with known cardiovascular disease. Results. Study population consisted of 1200 patients, 742 of them underwent elective surgery; age (median) 72.0 years, 66.2% males. 84.6% of patients were treated with antithrombotic therapy i.e. 439 aspirin, 31 DAPT, 192 oral anticoagulants. Prophylaxis of VTE in perioperative period was applied in 93.5%. In-hospital ischemic complications occurred in 3% (vs 9.8% in acutely operated patients, p0.001), bleeding complications in 10.90% (vs 12.0%, n.s.), and both of them in 0.7% (vs. 4.2%, p0.001). Mortality of patients, who underwent planned surgery, was 2.2% (vs. 6.8% in acute surgery, p0.001). Multivariate linear regression identified that pre-procedural anemia and history of (coronary or non-coronary) stent implantation were significantly related to ischemic complications. Periprocedural antithrombotic management has no impact on ischemic complications. Termination of warfarin less than 4 days before surgery was significantly related to the risk of bleeding. Conclusions. Risk of perioperative ischemic complications is significantly lower in cardiac patients who are undergoing non-cardiac surgery electively (in comparison to acutely), and this risk is significantly related to a history of preprocedural anemia and history of stent implantation. For prevention from periprocedural bleeding, warfarin should be discontinued more than 4 days before surgery