The impact of preoperative maintaining antithrombotic medications for clinical outcomes in patients undergoing non-coronary endovascular interventions

It is common for patients on antithrombotic medications to undergo endovascular interventions. This study aimed to evaluate the effects of preoperative maintaining antithrombotic medications on perioperative clinical outcomes, especially intraoperative blood transfusion, in patients undergoing these procedures. A total of 5743 patients who underwent endovascular interventions from January 2019 to December 2022 were identified and divided into four groups based on the preoperative antithrombotic medications. Clinical outcomes, including blood transfusion, hematoma and pseudoaneurysm, were analyzed using multivariate logistics regression. Subsequently, patients were stratified according to whether they received blood transfusion. All-cause mortality, adverse cardiovascular events and infectious events were used to evaluate the impact of blood transfusion. The stabilized inverse probability of treatment weights (IPTW) with using propensity score was employed to adjust for covariate imbalance. Compared to patients not receiving any antithrombotic medications, those undergoing dual antiplatelet therapy or anticoagulant therapy exhibited an increased risk of requiring blood transfusion (OR: 2.05, 95%CI: 1.30-3.23; OR: 1.92, 95%CI: 1.22-3.03). Additionally, patients receiving anticoagulant therapy demonstrated a higher risk of hematoma (OR: 2.71, 95% CI: 1.20-6.13). No significant difference in the incidence of pseudoaneurysm was observed. Subgroup analysis indicated that the risk of blood transfusion varied according to the type of anesthesia, number of puncture sites and renal function, with a significant interaction (P < 0.05). Patients who required blood transfusion had significantly higher rate of one-year all-cause mortality (HR: 2.18, 95% CI: 1.10-4.32) and three-month infectious events at three months (HR: 4.92, 95% CI: 1.72-14.06). Preoperative maintaining dual antiplatelet or anticoagulant therapy increased the risk of blood transfusion in endovascular interventions. Blood transfusion was independently associated with increased risk of all-cause mortality and infectious events. Interventional physicians should assess thrombosis and bleeding risks preoperatively, and determine whether to discontinue antithrombotic medications and avoid liberal blood transfusion.