title: Bleeding complications in patients with coronary stents during non-cardiac surgery.
abstract: BACKGROUND
  Patients with coronary stents often undergo non-cardiac invasive procedures. These are often associated with thrombotic and/or hemorrhagic complications. The type of procedure, perioperative antiplatelet therapy, and other patient-related factors influence the risk of postoperative haemorrhage. Our objective was to analyze the postoperative risk factors for hemorrhagic complications and to determine the impact of antiplatelet and anticoagulant therapy strategies on postoperative bleeding risk in patients with coronary stents undergoing non-cardiac surgery.
  
  
  METHODS
  Prospective, multicentre observational cohort study of 1134 consecutive patients with coronary stents undergoing non-cardiac surgery between April 2007 and April 2009. The primary outcome measure was the occurrence of an hemorrhagic complication during the first 30days following the surgery or intervention.
  
  
  RESULTS
  Among the 1134 patients evaluated, 108 (9.5%) experienced a postoperative hemorrhagic complication (with a median time to occurrence of 5.3days). These complications were considered major, involved the operative site, and required reoperation in 92 (85.2%), 92 (85.2%), and 20 (18.5%) of patients, respectively. Mortality in patients with a haemorrhagic complication was 12% (n=13). Independent postoperative factors associated with haemorrhagic complications were identified as a high and intermediate bleeding risk procedure and the use and dose of anticoagulants. When interrupted before the procedure, resumption of antiplatelet treatment was delayed in patients developing early postoperative hemorrhagic complications.
  
  
  CONCLUSIONS
  Patients with coronary stents who undergo surgery are at high risk for hemorrhagic complications.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Grenoble University Hospital, Grenoble, France; ThEMAS, TIMC, UMR, CNRS 5525, Univ. Grenoble Alpes, France. Electronic address: PAlbaladejo@chu-grenoble.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Albaladejo
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Grenoble University Hospital, Grenoble, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Charbonneau
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, Cochin University Hospital, Paris, France.
authors.forename: Charles-Marc
authors.initials: CM
authors.lastname: Samama
authors.affiliation: Cardiology Institute, Assistance Publique Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.affiliation: Department of Anaesthesiology, Institut Hospitalier Franco-Britannique, Levallois, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Marret
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Lyon-South University Hospital, Bron, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Piriou
authors.affiliation: ThEMAS, TIMC, UMR, CNRS 5525, Univ. Grenoble Alpes, France.
authors.forename: Celine
authors.initials: C
authors.lastname: Genty
authors.affiliation: ThEMAS, TIMC, UMR, CNRS 5525, Univ. Grenoble Alpes, France.
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Bosson
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D006801:Humans; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: General Surgery; Haemorrhage; Platelet Aggregation Inhibitors; Stents; Thrombosis