Safety of liver resection without interruption of antiplatelet therapy with aspirin for high-risk patients

Abstract

Introduction: The number of elderly people with hepatobiliary pancreatic diseases who require surgery has recently increased. Elderly patients are often treated with aspirin for the secondary prevention of ischemic stroke and cardiovascular events. Perioperative aspirin therapy is continued for patients who undergo liver resection at our institution. We evaluated the safety and feasibility of liver resection with continued antiplatelet therapy using aspirin. Methods: We retrospectively evaluated the outcomes of 570 patients who underwent liver resection between January 2010 and December 2017. Patients were grouped according to whether they received preoperative aspirin therapy (users, n = 50) or not (non-users, n = 520). Preoperative variables, intraoperative factors, and postoperative outcomes were compared between the two groups. Results: The preoperative factors of more advanced age (P < 0.001) and a higher proportion of males (P< 0.002), frequency of history of hypertension (P = 0.03), diabetes mellitus (P < 0.001), and ASA classification (P < 0.001) significantly differed between the two groups. Surgical duration, type of procedure, blood loss, and blood transfusion rate did not significantly differ between the two groups. No significant difference in 90- day mortality rates was evident between groups (users, 2.0%; non-users, 0.96%). None of the patients treated with aspirin developed uncontrollable excessive intra-operative bleeds or postoperative hemorrhage. Conclusions: Aspirin can be safely continued in patients undergoing liver resection without risk of increasing intraoperative bleeding or postoperative hemorrhagic morbidity. We suggest that aspirin should be continued perioperatively for patients at high risk of developing cardiovascular events.