Outcomes of patients on dual antiplatelet therapy post-coronary stenting following emergency noncardiac surgery.

Abstract

The outcomes of patients on dual antiplatelet therapy (DAPT) post-coronary stenting following emergency noncardiac surgery remain unclear. This retrospective cohort study included patients on DAPT post-coronary stenting who underwent emergency noncardiac surgery within 24hours of diagnosis from April 2007 to March 2018 where DAPT was discontinued within <5days for aspirin and 7days for P2Y12 inhibitors. Our primary outcome was 180-day mortality in these patients. We investigated factors associated with bleeding within 180days after surgery as our secondary outcome and exploratorily examined factors affecting 180-day mortality. Of 62,528 patients who underwent any surgery under general anaesthesia during the 11-year study period, 133 patients (0.22% of all and 1.41% of emergency surgical patients) were analysed. Among the eligible patients, 180-day mortality was 9.8% (13/133). Eighteen patients (13.5%) developed bleeding within 180days after surgery, which was the most common post-operative complication. Restarting antiplatelet agents <2days post-operatively (OR, 4.51; 95% CI, 1.56-13.0; P=0.005) and stent implantation at bifurcation lesions before surgery (OR, 3.28; 95% CI, 1.07-10.1; P=0.04) were associated with post-operative bleeding. Patients on haemodialysis had the worse prognosis (hazard ratio, 5.73; 95% CI, 1.87-17.5; P=0.002) in terms of 180-day mortality. The 180-day mortality following emergency noncardiac surgery was approximately 10% in patients on DAPT post-coronary stenting. Restarting antiplatelet agents earlier than 2days post-operatively and coronary stenting at bifurcation lesions were associated with bleeding within 180days after surgery.