Antithrombotic therapy and hemorrhagic complications in the perioperative period in patients with chronic limb threatening ischemia; [Антитромботическая терапия и геморрагические осложнения в периоперационном периоде у больных с хронической ишемией, угрожающей потерей конечности]

Objective. To evaluate the effect of various antithrombotic treatment regimens on the incidence of hemorrhagic complications that occur in the perioperative period in patients with chronic limb threatening ischemia. Material and methods. At the first stage, the medical histories and outpatient records of 766 patients with chronic limb threatening ischemia (from 2006 to 2020) were retrospectively analyzed in order to identify hemorrhagic complications and the antithrombotic therapy used. At the II – main stage, 114 patients were operated on from 2021 to 2023 who had one or more risk factors for major bleeding. Observation periods: hospital. Results. In the structure of bleeding at the first stage of the study, the most significant cohort of patients with hemorrhagic complications were taking acetylsalicylic acid in combination with warfarin (OR 1.14, 95% CI 0.394–3.298, р = 0.012), acetylsalicylic acid in combination with clopidogrel (OR 1.75, 95% CI 1.112–3.360, р = 0.014) and triple antithrombotic therapy (OR 20.22, 95% CI 6.202–65.921, р = 0.001). At stage II of the study, hemorrhagic complications were observed significantly often in patients taking triple antithrombotic therapy (OR 4.82, 95% CI 2.124–10.613, р = 0.003). Conclusion. The hemorrhagic complications that occur in the perioperative period during the use of various antithrombotic therapy regimens are observed in 4–5% of patients with CLTI. Analyzing the presented study, it should be noted that most often combinations of acetylsalicylic acid with warfarin, dual antiplatelet therapy as well as triple antithrombotic therapy, are associated with hemorrhagic complications. The proposed measures to prevent bleeding can reliably reduce the incidence of its development and associated complications. © 2024 Bakoulev National Medical Research Center for Cardiovascular Surgery. All rights reserved.