Perioperative management of the antiplatelet therapy in patients with ischemic heart disease undergoing noncardiac surgery

Abstract

Background: Antiplatelet treatment (APT) perioperative care in non-cardiac surgery (NCS) patients who have previously undergone percutaneous coronary intervention (PCI) is still a problem. Our goal was to figure out if serious adverse cardiac and cerebrovascular incidents (MACCE) and serious bleeding events (MBE) are connected with the various perioperative APT regimens, either single APT (SAPT) or dual APT (DAPT). Methods: This was prospective observational research that was conducted on one hundred adult patients ≥ 21 years known to have ischemic heart disease (IHD) on APT, either SAPT or DAPT, Patients having urgent NCS necessitating at least a 24-hour hospital stay. The incidence of MACCE and MBE during hospitalization or at 30 days after surgery was recorded. Amount and frequency of MACCE and MBE Patients who went through perioperative SAPT or DAPT were contrasted. Identifying the possible MACCE and MBE risk variables. Furthermore, central blockade-related neuraxial haemorrhagic episodes were reported. Results: The incidence of MACCE was 22.64% in patients on SAPT and 2.13% in patients on DAPT. the incidence of MBE was 3.77% in patients on SAPT and 17.02% in patients on DAPT. No neuraxial haemorrhage events had been recorded. Mortality rate was 5.66% and 4.26% in patients on SAPT and DAPT respectively.Conclusions: Perioperative DAPT associated with lower incidence of MACCE and a higher prevalence MBE than SAPT. As regard MACCE, their risk factors were BMI ≥30 kg/m2, previous myocardial infarction, ejection fraction ≤ 50%, RWMA and high-risk surgery. While, DAPT, antihyperlipidemic drugs and beta blocker drugs were protective factors. As regard MBE, their risk factors were BMI ≥30 kg/m2, high-risk surgery and DAPT and there were no protective factors for MBE.