Adherence to periprocedural antithrombotic treatment recommendations and its prognostic impact in patients with high ischemic and hemorrhagic risk

Introduction and objectives

To analyze the clinical impact of the inappropriate use of antithrombotic treatment in patients with high ischemic or hemorrhagic risk during the periprocedural/perisurgical period in Spain.

Methods

Prospective multicenter observational registry of patients receiving antiplatelet and/or anticoagulant therapy who required an intervention. The incidence of 30-day events was compared based on the peri-intervention management of antithrombotic treatment and the patients’ risk classification (high vs. moderate-to-low risk). The primary endpoint was a composite of death, cardiovascular ischemic events, or bleeding events classified as BARC 2 or higher.

Results

A total of 1152 patients were analyzed. Of these, 1.9% had both high ischemic and hemorrhagic risks (A);10.8% had high ischemic risk and low-to-moderate hemorrhagic risk (B); 12% had high hemorrhagic risk and low-to-moderate ischemic risk (C); and 75.3% had both low-to-moderate risks (D). The prevalence of inappropriate treatment was higher in the subgroup with high hemorrhagic risk and low-to-moderate ischemic risk (C) (62.6% vs 40.9% in subgroup A; P < .05; 40.3% in subgroup B; P < .001; and 39.8% in subgroup D; P < .05). The incidence of the composite endpoint was higher in the subgroups with high ischemic and hemorrhagic risks (22.7%) and high ischemic and low-to-moderate hemorrhagic risks (20.9%), compared with 3.6% in subgroup C (P < .05) and 5.7% in subgroup D (P < .001). Among patients with inappropriate treatment, the incidence of the composite endpoint was significantly higher in subgroups with high ischemic and hemorrhagic risks (44.4% vs 7.7%; P = .043) and high ischemic and low-to-moderate hemorrhagic risks (30% vs 14.8%; P = .042).

Conclusions

The prevalence of inappropriate periprocedural/perisurgical treatment was higher in patients with high hemorrhagic risk and low-to-moderate ischemic risk. The incidence of events was higher in patients with high ischemic risk, with inadequate antithrombotic management being associated with a higher event rate in these groups.