Vascular complications and coagulation-related changes in the perioperative period in japanese patients undergoing non-cardiac surgery

Aim: To properly assess the guidance for perioperative management, we undertook a clinical epidemiology study with the primary aim of evaluating the incidence of perioperative vascular complications and their associated factors in a cohort of Japanese patients who underwent non-cardiac surgery in a tertiary medical care center. Methods: This observational study comprised two parts. In the first part, thrombotic and bleeding events and their risk factors in the perioperative period were evaluated in a total of 2,654 consecutive patients. In the second part, perioperative changes in coagulation-related factors, including the thrombin-antithrombin complex (TAT) and platelet aggregation activity, were serially characterized in 82 individuals randomly chosen from the consecutive patients. Results: The incidence of perioperative vascular complications was as follows: 1.0% for major bleeding, 0.21% for stroke and 0.21% for venous thromboembolism. No episodes of symptomatic myocardial infarction were identified in the studied population. Perioperative changes in coagulationrelated factors were found to be complex and correlated in the mixed direction of pro- and anticoagulation. The TAT values showed prolonged (across postoperative days 1-5) and prominent (>116% increase) perioperative activation of coagulation, whereas global coagulation parameters, such as the prothrombin time, showed a tendency of anticoagulation in the immediate postoperative period. Conclusions: Our data confirm the relatively low incidence of perioperative vascular complications in the general Japanese non-cardiac surgical population. Given the delicate balance between thrombotic and bleeding events, it is important to comprehensively understand the associations between the patient's baseline risk factors and vascular complications for effective clinical management.