PB0004 - Discontinue or continue acetylsalicylic acid in patients at high risk of atherothrombotic disease who are undergoing major surgery: the balance between thrombosis and bleeding

Sunday, June 23, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Co-Author(s)

ML

María Graciela Leal Gutiérrez

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico
Marilyn G. Mendoza, MD

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico
Margarita M. Thomas, MD

Medical Resident on Thrombosis and Hemostasis
1Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico city, Distrito Federal, Mexico
Andric Cuevas-Juárez, MD

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico city, Distrito Federal, Mexico
Stephania Sandoval Ocampo, Hematologist

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Ciudad de méxico, Mexico City, Mexico
Emely J. Soriano, MD

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico
TM

Tania Marisol Martinez Garcia

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico
Jose A. Aguilar

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Ciudad de México, Distrito Federal, Mexico

Presenting Author(s)

Adriana G. Garcia

Medical resident on thrombosis and hemostasis
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico

Co-Author(s)

Abraham S. Majluf

Head of the thrombosis and hemostasis unit
Unidad de Investigación Médica en Trombosis, Hemostasia y Aterogénesis, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Mexico City, Distrito Federal, Mexico

Background: Worldwide, population >65 years-old is growing at the fastest rate. This has led to an increased use of acetylsalicylic acid (ASA) for prevention of atherothrombotic events. Management of patients receiving ASA in the perioperative period is a common scenario. However, consensus on how to manage these patients is missing. The decision to continue ASA in non-cardiac surgical patients requires a balance between thrombotic vs. hemorrhagic risks.

Aims: To investigate whether continuation/discontinuation of ASA in high-risk atherothrombotic patients undergoing major surgery affects thrombotic events and major bleeding.

Methods: . A prospective, descriptive, controlled, single-blind 22-year follow-up period. Only adult patients were included. Thrombotic and hemorrhagic events were objectively assessed (ISTH criteria).

Results: A total of 818 patients were identified between January 2,000 and December 2,022, of whom 380 discontinued ASA and 438 continued. Incidence of postoperative thrombotic events was significantly higher in the group that discontinued ASA (11% vs. 3.4%, p=0.01). Incidence of thrombotic events was higher in the first 10 days after surgery: 81% in the ASA withdrawal group vs. 60% in the continued ASA group. Among 297 bleeding events observed, 135 occurred in patients who stopped ASA, compared to 162 in those who continued (p=0.59). The rate of major bleeding was also non-significant between the groups.

Conclusion(s): According to the results of our study, patients at high risk of atherothrombotic events requiring major non-cardiac surgery have a reduced risk of thrombotic events and no increased risk of bleeding complications when ASA is maintained perioperatively.