Risk-adjusted perioperative bridging anticoagulation reduces bleeding complications without increasing thromboembolic events in general and visceral surgery

BACKGROUND

Perioperative bridging of oral anticoagulation increases the risk of bleeding complications after elective general and visceral surgery. The aim of this study was to explore, whether an individual risk-adjusted bridging regimen can reduce bleeding events, while still protecting against thromboembolic events.

METHODS

We performed a quality improvement study comparing bridging parameters and postoperative outcomes before (period 1) and after implementation (period 2) of a new risk-adjusted bridging regimen. The primary endpoint of the study was overall incidence of postoperative bleeding complications during 30 days postoperatively. Secondary endpoints were major postoperative bleeding, minor bleeding, thromboembolic events, postoperative red blood cell transfusion, perioperative length-of-stay (LOS) and in-hospital mortality.

RESULTS

A total of 263 patients during period 1 and 271 patients during period 2 were compared. The included elective operations covered the entire field of general and visceral surgery. The overall incidence of bleeding complications declined from 22.1% during period 1 to 10.3% in period 2 (p < 0.001). This reduction affected both major as well as minor bleeding events (8.4% vs. 4.1%; p = 0.039; 13.7% vs. 6.3%; p = 0.004). The incidence of thromboembolic events remained low (0.8% vs. 1.1%). No changes in mortality or length-of-stay were observed.

CONCLUSION

It is important to balance the individual thromboembolic and bleeding risks in perioperative bridging management. The risk adjusted bridging regimen reduces bleeding events in general and visceral surgery while the risk of thromboembolism remains comparably low.

Effect of low-molecular heparin on therapeutic effect and renal function in patients with gastric cancer

AIM

To evaluate the effect of low-molecular heparin on therapeutic effect and renal function in patients with gastric cancer.

METHODS

Ninety-six patients with gastric carcinoma treated at our hospital from May 2013 to December 2015 were randomly divided into either a control group or an observation group, with 48 cases in each group. The control group was treated with standard chemotherapy, and the observation group was additionally given subcutaneous injections of low molecular heparin on the basis of standard chemotherapy. Therapeutic effect, rate of complications, and renal damage index were compared between the two groups.

RESULTS

After two courses of treatment, the total effective rate was significantly higher in the observation group than in the control group (85.42% vs 64.58%, χ² = 5.556, P = 0.018); blood urea nitrogen, serum creatinine, albumin/serum creatinine ratio, and urine N-acetyl-β-D-glucosamidase/serum creatinine ratio were significantly lower in the observation group than in the control group (P < 0.01); and the rates of gastrointestinal reaction, deep venous thrombosis, pulmonary embolism and liver and kidney dysfunction were significantly lower in the observation group than in the control group (P < 0.05). However, the incidence of bleeding in the two groups showed no significant difference (P > 0.05).

CONCLUSION

Treatment with low-molecular heparin can obviously improve the therapeutic effect in gastric cancer patients, shorten the treatment course, and reduce the economic burden of the family, and is associated with fewer complications in gastric cancer patients. Low-molecular heparin has obvious anticoagulant effect and can improve renal function in patients with gastric cancer.