Impact of antiplatelet therapy on increased blood loss and bleeding complication in patients undergoing urgent cholecystectomy for acute cholecystitis

Abstract

Background: The impact of antiplatelet therapy (APT) on surgical blood loss (SBL) and postoperative bleeding complications (PBCs) in patients receiving emergency cholecystectomy for acute cholecystitis (AC) still remains unknown. Methods: A total of 243 consecutive AC patients undergoing emergency cholecystectomy were reviewed. In patients receiving APT (APT group, n=89), surgery was performed without preoperative reversal of the APT effect. Perioperative and outcome variables of the APT group were compared with those of patients without APT (non-APT group, n=154). Results: In this cohort, 106 laparoscopic and 137 open operations were included. There were 18 patients with increased SBL (>=500mL, 7.4%) and 7 PBCs (2.9%). Patients with APT showed higher occurrence of Grade 3 acute cholecystitis (46% vs 28%, p=0.005) and less frequently received laparoscopic surgery (34% vs 49%, p=0.022) compared to those in the non-APT group. Multivariate analyses showed that Grade 3 acute cholecystitis (HR=2.76, p=0.046) and male gender (HR=12.99, p=0.017), but not APT use or laparoscopic surgery, were independent prognostic factors for increased SBL. However, increased PBCs were significantly associated with use of multiple APT (HR=14.85, p=0.044) and anticoagulation (HR=47.18, p=0.002). Conclusion: Single APT does not pose a risk for either SBL or PBCs after emergency cholecystectomy for acute cholecystitis, whereas patients with multiple APT or anticoagulation still represent a challenging group and need to be rigorously managed.