XVIII Congress of the Italian Society for Hemostasis and Thrombosis Research, Rome, Sept. 30-Oct. 3, <strong>2004</strong>177PO-161SURGERY IN PATIENTS ON LONG TERM ORAL ANTICOAGULANTTREATMENT (OAT): A PROSPECTIVE OBSERVATIONAL STUDYBaudo F, Ghirarduzzi A,^ Mostarda G, Molinatti M, +Pengo V,^^ Poli D, Tiraferri E,° Tosetto A,* Morra Eon behalf of FCSA (Federazione Centri SorveglianzaAnticoagulati)Niguarda Hospital, Milan; ^Santa Maria NuovaHospital, Reggio Emilia; + Maria Vittoria Hospital,Tori<strong>no</strong>; ^^Ex Busonera Hospital, Padua; Universityof Florence; °Ospedale degli Infermi, Rimini; SanBortolo Hospital, Vicenza, ItalyThe perioperative management of patients (pts) onlong term OAT is an increasing issue in clinical practice.When surgery is carried out the problem arisesof balancing the thromboembolic (TE) with thebleeding risk. The issue is unsettled. The therapeuticoptions are: discontinuation of OAT to obtain an INRvalue
178PostersPO-163BLEEDING RISK IN PATIENTS RECEIVING BOTH ORALANTICOAGULANT AND ANTIPLATELET THERAPYPoli D, Antonucci E, Cecchi E, Mannini L, Ilari I,Ferrini S, Gazzini A, Coppo M, Falciani M,Gensini GF, Abbate R, Prisco DCentro di Riferimento Regionale per la Trombosi,Dipartimento dell’Area Critica Medico Chirurgica,Azienda Ospedaliero-Universitaria Careggi,Florence, ItalyIn selected patients oral anticoagulant therapy(OAT) can<strong>no</strong>t sufficiently prevent thrombotic eventsand the association of antiplatelet therapy (APT) isrequired. This practice is debatable because ofincreased risk of bleeding. Aim of our study was toevaluate the rate of adverse events in patientsreceiving OAT+APT treatments. We studied 1596consecutive unselected patients (942 males and 654females; mean age 64±13.1 yrs; follow-up 3364patient-years), referred to our Anticoagulation Clinicfor OAT monitoring. Among these patients, 44 (33males and 11 females; mean age 64.6±11.7 yrs)received also APT, for a total period of 115 patientyears.Patients received both treatments for differentindications: mechanical prosthetic heart valves (13),arterial vascular disease (12), coronary artery disease(13), atrial fibrillation with embolic complication (4),other indications (2). Looking at the quality of OAT,time spent within, above and below the intendedtherapeutic range was similar in treated or <strong>no</strong>t withAPT (67%, 15% and 18% in the whole populationand 70%, 15% and 15% in patients with APT). 2/44APT patients had major bleeding events (1.7/100patient-years), <strong>no</strong>ne was fatal. In all the otherpatients we recorded 36/1552 major bleeding eventswith a similar rate of incidence (1.1/100 patientyears),3 were fatal (p=0.5). 9/44 APT patients hadmajor thrombotic events (rate 7.8/100 patientyears),<strong>no</strong>ne was fatal. In all the other patients, werecorded 95/1552 major thrombotic events (rate2.9/100 patient-years), 3 were fatal. This differencewas statistically significant [RR 2.6 (1.1-5.3 95%CI) p=0.01], and may reflect the higher thromboticrisk that lead to the choice of adding APT to OAT. Inconclusion, patients at high thrombotic risk whoreceived OAT associated with APT seems <strong>no</strong>t to be atsignificantly higher risk of serious bleeding.FCSA PrizePO-164ORAL ANTICOAGULANT TREATMENT FOR STROKE PREVENTIONIN ATRIAL FIBRILLATION PATIENTS: FEMALES ARE STILL ATRISKPoli D, Cecchi E, Antonucci E, Mannini L, Gensini F,Lucarini L, Saracini C, Attanasio M, Fatini C,Gensini GF, Abbate R, Prisco DCentro di Riferimento Regionale per la Trombosi,Dipartimento dell’ Area Critica Medico Chirurgica,Azienda Ospedaliero-Universitaria Careggi,Florence, ItalyOver the last years, oral anticoagulant treatment(OAT), has become the cornerstone for stroke preventionin patients with atrial fibrillation (AF). Thisstudy was aimed at evaluating the efficacy and safetyof OAT managing in a real-practice situation. Westudied 1596 consecutive unselected patients (follow-up3364 patient-years), referred for the controlof OAT to our Anticoagulation Clinic. Among thesepatients, AF was the indication for OAT in 558 (35%)(follow-up 958 patient-years). Looking at the qualityof OAT, time spent within, above and below theintended therapeutic range was 66%, 16% and 18%respectively in the whole population and 71%, 13%and 16% in AF patients. 12/558 AF patients hadmajor bleeding events (1.2/100 patient-years), 2were fatal. In all the other patients, we recorded26/1038 major bleeding events with a similar rate ofincidence (1.1/100 patient-years), one was fatal. Inboth groups females showed a trend to higher risk ofbleeding (p=0.4). 26/558 AF patients had thromboticevents, 17 of which were major (2.7 and1.7/100 patient-years, respectively), one was fatal.The other patients had 78/1038 thrombotic events,46 of which were major (3.2 and 2.2/100 patientyears,respectively). In all patients <strong>no</strong> significant differencewas found in the rate of total thromboticcomplications in relation to sex. Instead, the rate ofstroke in patients with AF was significantly higher infemales with respect to males (1.87 and 0.5/100patient-years respectively; [RR 3.7 (1.0-22.2 95%CI;p=0.05)]. This difference was <strong>no</strong>t found in patientson OAT for others reasons (RR 1.4 (0.5-3.6 95% CI;p=0.3). On the whole AF patients on OAT show a lowrate of complications however, females show a trendto high risk of bleeding and are at higher risk ofstroke in spite of OAT.haematologica vol. <strong>89</strong>(suppl. n. 8):september <strong>2004</strong>
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