Prevention of Perioperative Bleeding in Patients With Chronic Limb-Threatening Ischemia
Materials and methods: At stage I, we retrospectively studied histories and outpatient medical records of 766 patients with chronic limb-threatening ischemia (from 2006 to 2020) to identify hemorrhagic complications and potential risk factors for their development. We analyzed the effectiveness of d...
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Scientific Research Institute, Ochapovsky Regional Clinical Hospital no. 1
2024-03-01
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| Series: | Инновационная медицина Кубани |
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| Online Access: | https://www.innovmedkub.ru/jour/article/view/810 |
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| author | D. A. Maximkin V. A. Khalabuzar Z. Kh. Shugushev A. G. Chepurnoy A. G. Faybushevich E. A. Gitelzon |
| author_facet | D. A. Maximkin V. A. Khalabuzar Z. Kh. Shugushev A. G. Chepurnoy A. G. Faybushevich E. A. Gitelzon |
| author_sort | D. A. Maximkin |
| collection | DOAJ |
| description | Materials and methods: At stage I, we retrospectively studied histories and outpatient medical records of 766 patients with chronic limb-threatening ischemia (from 2006 to 2020) to identify hemorrhagic complications and potential risk factors for their development. We analyzed the effectiveness of different scores for assessment of the bleeding risk. Based on the obtained data, measures to prevent hemorrhagic complications in this cohort of patients were improved. During stage II, 114 patients with 1 or several risk factors for major bleeding underwent surgery between 2021 and 2023. We used the proposed and improved preventive measures for all the patients. Follow-up periods were during the hospital stay and in 6 and 12 months.Results: At stage I, 44 (5.74%) patients were found to have hemorrhagic complications in the early postoperative period: retroperitoneal hematoma, bleeding from an operating wound, and pulsating hematoma (15.9%); gastrointestinal hemorrhage (31.8%); gross hematuria (13.7%), and hemorrhagic stroke (6.8%). The most significant risk factors for bleeding were endovascular intervention using brachial and femoral approaches (P = .000), hybrid intervention (P = .000), dual antiplatelet therapy (P = .014), surgery duration above 60 minutes (P = .001), triple antithrombotic therapy (P = .001), and significant vascular calcification (P = .023). The PRECISE-DAPT score has proven to be of prognostic value (P = .073; odds ratio, 2.88). At stage II, due to the proposed preventive measures, bleeding that required blood transfusion was found in 5 (4.38%) of 114 patients: of them, 1 (0.9%) patient had acute coronary syndrome. There were no major amputations, whereas 3 (2.63%) patients underwent minor amputation. In 6 and 12 months of the follow-up, the total frequency of major cardiovascular complications (cardiac death, myocardial infarction), major and minor amputation was 0.9% and 2.6%, 0% and 1.75%, and 0.9% and 2.6%, respectively.Conclusions: Surgical treatment of patients with chronic limb-threatening ischemia and risk factors for hemorrhagic complications who underwent surgery with the proposed preventive measures demonstrated high efficiency in reducing the number of hemorrhages and associated cardiac complications and low frequency of major and minor amputations in the long-term follow-up. |
| format | Article |
| id | doaj-art-fae5db1d01934f72a73089b00a5404b5 |
| institution | Kabale University |
| issn | 2541-9897 |
| language | English |
| publishDate | 2024-03-01 |
| publisher | Scientific Research Institute, Ochapovsky Regional Clinical Hospital no. 1 |
| record_format | Article |
| series | Инновационная медицина Кубани |
| spelling | doaj-art-fae5db1d01934f72a73089b00a5404b52025-08-20T03:47:32ZengScientific Research Institute, Ochapovsky Regional Clinical Hospital no. 1Инновационная медицина Кубани2541-98972024-03-0101535910.35401/2541-9897-2024-9-1-53-59426Prevention of Perioperative Bleeding in Patients With Chronic Limb-Threatening IschemiaD. A. Maximkin0V. A. Khalabuzar1Z. Kh. Shugushev2A. G. Chepurnoy3A. G. Faybushevich4E. A. Gitelzon5Patrice Lumumba Peoples’ Friendship UniversityPatrice Lumumba Peoples’ Friendship UniversityPatrice Lumumba Peoples’ Friendship UniversityPatrice Lumumba Peoples’ Friendship UniversityPatrice Lumumba Peoples’ Friendship UniversityPatrice Lumumba Peoples’ Friendship UniversityMaterials and methods: At stage I, we retrospectively studied histories and outpatient medical records of 766 patients with chronic limb-threatening ischemia (from 2006 to 2020) to identify hemorrhagic complications and potential risk factors for their development. We analyzed the effectiveness of different scores for assessment of the bleeding risk. Based on the obtained data, measures to prevent hemorrhagic complications in this cohort of patients were improved. During stage II, 114 patients with 1 or several risk factors for major bleeding underwent surgery between 2021 and 2023. We used the proposed and improved preventive measures for all the patients. Follow-up periods were during the hospital stay and in 6 and 12 months.Results: At stage I, 44 (5.74%) patients were found to have hemorrhagic complications in the early postoperative period: retroperitoneal hematoma, bleeding from an operating wound, and pulsating hematoma (15.9%); gastrointestinal hemorrhage (31.8%); gross hematuria (13.7%), and hemorrhagic stroke (6.8%). The most significant risk factors for bleeding were endovascular intervention using brachial and femoral approaches (P = .000), hybrid intervention (P = .000), dual antiplatelet therapy (P = .014), surgery duration above 60 minutes (P = .001), triple antithrombotic therapy (P = .001), and significant vascular calcification (P = .023). The PRECISE-DAPT score has proven to be of prognostic value (P = .073; odds ratio, 2.88). At stage II, due to the proposed preventive measures, bleeding that required blood transfusion was found in 5 (4.38%) of 114 patients: of them, 1 (0.9%) patient had acute coronary syndrome. There were no major amputations, whereas 3 (2.63%) patients underwent minor amputation. In 6 and 12 months of the follow-up, the total frequency of major cardiovascular complications (cardiac death, myocardial infarction), major and minor amputation was 0.9% and 2.6%, 0% and 1.75%, and 0.9% and 2.6%, respectively.Conclusions: Surgical treatment of patients with chronic limb-threatening ischemia and risk factors for hemorrhagic complications who underwent surgery with the proposed preventive measures demonstrated high efficiency in reducing the number of hemorrhages and associated cardiac complications and low frequency of major and minor amputations in the long-term follow-up.https://www.innovmedkub.ru/jour/article/view/810hemorrhagic complicationsbleedingpreventive measureschronic limb-threatening ischemia |
| spellingShingle | D. A. Maximkin V. A. Khalabuzar Z. Kh. Shugushev A. G. Chepurnoy A. G. Faybushevich E. A. Gitelzon Prevention of Perioperative Bleeding in Patients With Chronic Limb-Threatening Ischemia Инновационная медицина Кубани hemorrhagic complications bleeding preventive measures chronic limb-threatening ischemia |
| title | Prevention of Perioperative Bleeding in Patients With Chronic Limb-Threatening Ischemia |
| title_full | Prevention of Perioperative Bleeding in Patients With Chronic Limb-Threatening Ischemia |
| title_fullStr | Prevention of Perioperative Bleeding in Patients With Chronic Limb-Threatening Ischemia |
| title_full_unstemmed | Prevention of Perioperative Bleeding in Patients With Chronic Limb-Threatening Ischemia |
| title_short | Prevention of Perioperative Bleeding in Patients With Chronic Limb-Threatening Ischemia |
| title_sort | prevention of perioperative bleeding in patients with chronic limb threatening ischemia |
| topic | hemorrhagic complications bleeding preventive measures chronic limb-threatening ischemia |
| url | https://www.innovmedkub.ru/jour/article/view/810 |
| work_keys_str_mv | AT damaximkin preventionofperioperativebleedinginpatientswithchroniclimbthreateningischemia AT vakhalabuzar preventionofperioperativebleedinginpatientswithchroniclimbthreateningischemia AT zkhshugushev preventionofperioperativebleedinginpatientswithchroniclimbthreateningischemia AT agchepurnoy preventionofperioperativebleedinginpatientswithchroniclimbthreateningischemia AT agfaybushevich preventionofperioperativebleedinginpatientswithchroniclimbthreateningischemia AT eagitelzon preventionofperioperativebleedinginpatientswithchroniclimbthreateningischemia |