American journal of translational research · 2026
Perioperative antiplatelet management in CAD patients undergoing spinal fusion: balancing cardiovascular safety and bleeding risk.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Liu Ziyun, Zhou Jie, Yan Pan, Chen Dan, Xu Jing
Аннотация
BACKGROUND: For patients with coronary artery disease (CAD) who require long-term antiplatelet therapy, controversy remains regarding perioperative drug management strategies during spinal fusion surgery, with balancing thrombotic and bleeding risks being key to clinical decision-making.
OBJECTIVE: This study aims to retrospectively compare the impact of four perioperative antiplatelet drug management strategies (continuing medication, discontinuing medication 5 days before surgery, discontinuing medication 7 days before surgery, and bridging therapy) on cardiovascular safety and bleeding risk in CAD patients undergoing spinal fusion surgery.
METHODS: This is a single-center retrospective cohort study. It includes 325 patients with CAD who underwent elective spinal fusion surgery between January 2018 and December 2023. Patients were divided into four groups based on their perioperative antiplatelet management strategy. The primary outcome was major adverse cardiovascular events (MACE) within 30 days post-surgery, while secondary outcomes included bleeding events, intraoperative blood loss, postoperative drainage volume, and transfusion requirements.
RESULTS: Baseline characteristics were generally balanced across the four groups. The group continuing medication had the highest incidence of bleeding events (31.9%), whereas the group discontinuing medication 7 days preoperatively had the lowest (6.7%), with significant differences observed (P<0.001). Regarding cardiovascular events, the incidence was relatively lower in the group continuing medication, with higher risk in the discontinuation groups (especially the 5-day discontinuation group); multivariate regression showed that discontinuing medication for 5 days was an independent risk factor for MACE (OR=3.87, P=0.038). The bridging therapy group exhibited intermediate levels of both bleeding and cardiovascular risk. Intraoperative blood loss and postoperative transfusion rates were also significantly higher in the continuing medication group.
CONCLUSIONS: In spinal fusion surgeries among CAD patients, continuing antiplatelet medication provides better cardiovascular protection but significantly increases bleeding risk; discontinuing medication preoperatively can effectively reduce bleeding complications but may increase the risk of cardiovascular events; while bridging therapy achieves a relative balance between the two. Clinical decisions should be individualized, comprehensively assessing the patient's thrombotic and bleeding risks.
OBJECTIVE: This study aims to retrospectively compare the impact of four perioperative antiplatelet drug management strategies (continuing medication, discontinuing medication 5 days before surgery, discontinuing medication 7 days before surgery, and bridging therapy) on cardiovascular safety and bleeding risk in CAD patients undergoing spinal fusion surgery.
METHODS: This is a single-center retrospective cohort study. It includes 325 patients with CAD who underwent elective spinal fusion surgery between January 2018 and December 2023. Patients were divided into four groups based on their perioperative antiplatelet management strategy. The primary outcome was major adverse cardiovascular events (MACE) within 30 days post-surgery, while secondary outcomes included bleeding events, intraoperative blood loss, postoperative drainage volume, and transfusion requirements.
RESULTS: Baseline characteristics were generally balanced across the four groups. The group continuing medication had the highest incidence of bleeding events (31.9%), whereas the group discontinuing medication 7 days preoperatively had the lowest (6.7%), with significant differences observed (P<0.001). Regarding cardiovascular events, the incidence was relatively lower in the group continuing medication, with higher risk in the discontinuation groups (especially the 5-day discontinuation group); multivariate regression showed that discontinuing medication for 5 days was an independent risk factor for MACE (OR=3.87, P=0.038). The bridging therapy group exhibited intermediate levels of both bleeding and cardiovascular risk. Intraoperative blood loss and postoperative transfusion rates were also significantly higher in the continuing medication group.
CONCLUSIONS: In spinal fusion surgeries among CAD patients, continuing antiplatelet medication provides better cardiovascular protection but significantly increases bleeding risk; discontinuing medication preoperatively can effectively reduce bleeding complications but may increase the risk of cardiovascular events; while bridging therapy achieves a relative balance between the two. Clinical decisions should be individualized, comprehensively assessing the patient's thrombotic and bleeding risks.