Abstract
PurposeThe number of patients on antiplatelet therapy (APT) who need surgery is increasing; however, it is unclear whether APT should be continued for abdominal surgery, particularly laparoscopic colorectal surgery. We investigated the safety of continuing APT for patients undergoing laparoscopic colorectal surgery.MethodsWe collected retrospective data from 529 patients who underwent laparoscopic colorectal surgery at Hiroshima University between January, 2013 and December, 2018. We analyzed information related to APT. Thirty-six pairs were matched by the propensity score method between patients on APT (APT+) and those not on APT (APT−). We compared the surgical outcomes of both groups.ResultsAmong 463 patients eligible for the study, 48 were on APT for cerebrovascular or cardiovascular disease, and 36 continued to take aspirin. In the case-matched comparison, the amount of intraoperative blood loss in the APT+ group was not significantly higher than that in the APT− group, and the incidences of bleeding complications, thromboembolic complications, and other complications were not significantly different between the groups.ConclusionIn a case-matched comparison, continuation of aspirin during laparoscopic colorectal surgery did not increase perioperative complications. In laparoscopic colorectal surgery, continuation of aspirin is an acceptable strategy for patients with thromboembolic risk caused by interruption of APT.
Highlights
Antiplatelet therapy (APT) is indicated for the prevention of primary and late thrombotic complications in patients with thrombotic diseases, such as cerebrovascular or cardiovascular disease
We investigated the safety of APT for laparoscopic colorectal surgery with the continuation of APT, while considering variations in the surgical procedures
A meta-analysis revealed that aspirin continuation was not generally associated with higher mortality rates or poorer surgery outcomes, but it was associated with a 1.5-fold increase in perioperative blood loss [5]
Summary
Antiplatelet therapy (APT) is indicated for the prevention of primary and late thrombotic complications in patients with thrombotic diseases, such as cerebrovascular or cardiovascular disease. Biondi-Zoccai reported that the withdrawal of aspirin treatment had ominous prognostic implications for patients at moderate-to-high risk for coronary artery disease and concluded that aspirin should be discontinued only when bleeding risk clearly overwhelms that of thrombotic events [3] It remains unclear which situations should be given priority to interrupt APT. A meta-analysis revealed that aspirin continuation was not generally associated with higher mortality rates or poorer surgery outcomes, but it was associated with a 1.5-fold increase in perioperative blood loss [5] Another meta-analysis suggested that APT at the time of non-cardiac surgery confers minimal bleeding risk with no difference in thrombotic complications [6]. Based on the findings of these investigations of intraoperative bleeding risk from APT, the safety profile for laparoscopic colorectal surgery while continuing APT remains unclear
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