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Perioperative antiplatelet therapy and cardiovascular outcomes in patients undergoing joint and spine surgery.
- Source :
-
Journal of Clinical Anesthesia . Dec2016, Vol. 35, p163-169. 7p. - Publication Year :
- 2016
-
Abstract
- <bold>Study Objective: </bold>Perioperative thrombotic complications after orthopedic surgery are associated with significant morbidity and mortality. The use of aspirin to reduce perioperative cardiovascular complications in certain high-risk cohorts remains controversial. Few studies have addressed aspirin use, bleeding, and cardiovascular outcomes among high-risk patients undergoing joint and spine surgery.<bold>Design/setting/patients: </bold>We performed a retrospective comparison of adults undergoing knee, hip, or spine surgery at a tertiary care center during 2 periods between November 2008 and December 2009 (reference period) and between April 2013 and December 2013 (contemporary period).<bold>Measurements: </bold>Patient demographics, comorbidities, management, and outcomes were ascertained using hospital datasets.<bold>Main Results: </bold>A total of 5690 participants underwent 3075 joint and spine surgeries in the reference period and 2791 surgeries in the contemporary period. Mean age was 61±13 years, and 59% were female. In the overall population, incidence of myocardial injury (3.1% vs 5.8%, P<.0001), hemorrhage (0.2% vs 0.8%, P=.0009), and red blood cell transfusion (17.2% vs 24.8%, P<.001) were lower in the contemporary period. Among 614 participants with a preoperative diagnosis of coronary artery disease (CAD), in-hospital aspirin use was significantly higher in the contemporary period (66% vs 30.7%, P<.0001); numerically, fewer participants developed myocardial injury (13.5% vs 19.3%, P=.05), had hemorrhage (0.3% vs 2.1%, P=.0009), and had red blood cell transfusion (37.2% vs 44.2%, P<.001) in the contemporary vs reference period.<bold>Conclusions: </bold>In a large tertiary care center, the incidence of perioperative bleeding and cardiovascular events decreased over time. In participants with CAD, perioperative aspirin use increased and appears to be safe. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ASPIRIN
*MEDICATION safety
*ORTHOPEDIC surgery
*THROMBOSIS complications
*SPINAL surgery
*PLATELET aggregation inhibitors
*CORONARY heart disease complications
*THROMBOSIS prevention
*COMPARATIVE studies
*CORONARY disease
*RED blood cell transfusion
*HEMORRHAGE
*RESEARCH methodology
*MEDICAL cooperation
*RESEARCH
*RESEARCH funding
*SURGICAL complications
*THROMBOSIS
*EVALUATION research
*SPECIALTY hospitals
*TREATMENT effectiveness
*DISEASE incidence
*RETROSPECTIVE studies
*PERIOPERATIVE care
*SURGICAL blood loss
*THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 09528180
- Volume :
- 35
- Database :
- Academic Search Index
- Journal :
- Journal of Clinical Anesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 119584063
- Full Text :
- https://doi.org/10.1016/j.jclinane.2016.07.028