Poster No. 138 Thromboembolic and bleeding risks due to perioperative stop of antithrombotic treatment in non-cardiac surgery - a single center experience

Discontinuation of antiplatelet therapy is essential for patients in the perioperative period submitted to high bleeding risk non-cardiac surgery (NCS). Similarly, oral anticoagulants should be interrupted before high risk surgical procedures, excluding patients with mechanical heart valves together with any thromboembolic risk factors. Interruption of this medication may increase thromboembolic events, however, their frequency still remains unclear.

We aim to evaluate the thromboembolic and bleeding events due to perioperative cessation of antithrombotic treatment in non-cardiac surgery approach in the population in our center.

A single-center retrospective observational analysis between January 2015 and August 2022 evaluated 356 patients. Eligibility criteria included: interruption of antithrombotic or anticoagulant therapy, high cardiovascular risk with previous cardiovascular disease diagnosis, planned major non-cardiac surgery, and perioperative follow-up at our center.

A total 356 patients undergoing NCS were eligible in the cohort: 91.2% of patients with high bleeding risk surgery and 94.5% with mild-moderate thrombotic risk.

All cause death occurred in 4 patients (1.1%), thrombotic events in 4 patients (1.1%) and major bleeding events in 11 patients (3.1%). Hemoglobin level (P = 0.004), duration of surgery (P < 0.001) and age (P = 0.004) were significantly related to the risk of bleeding events. Mean duration of interruption of antithrombotic therapy was of 8 ± 2 days.

Although cessation of antithrombotic therapy, hemorrhagic events are more associated than thrombotic ones in patients with previous cardiac disease that underwent elective NCS. The factors with significant association with bleeding complications after NCS were age, hemoglobin level, and duration of surgery.