Management of Patients Receiving Antiplatelet Therapy During Gastroenterological Surgery-Reference-Cited by-同舟云学术

Management of Patients Receiving Antiplatelet Therapy During Gastroenterological Surgery

Published:2023-10-23 Issue: Volume: Page:
ISSN:0003-4932
Container-title:Annals of Surgery
language:en
Short-container-title:

Author:

Fujikawa Takahisa¹,Hasegawa Suguru²,Takahashi Ryo¹³,Naito Shigetoshi¹²,Kaihara Satoshi⁴,Uryuhara Kenji⁴,Hirata Keiji⁵,Tamura Toshihisa⁵,Terajima Hiroaki⁶,Kawai Takayuki⁶,Okabe Hiroshi⁷,Machimoto Takafumi⁸,Tanaka Hirokazu⁸,Honma Shusaku⁹,Furumoto Katsuyoshi¹⁰,Honda Goro¹¹,Uemura Shuichiro¹¹,Nishitai Ryuta³,Hida Koya¹²,Aoyama Ryuhei¹²,Wada Seidai¹³,Hirose Tetsuro¹⁴,Obama Kazutaka¹²

Affiliation:

1. Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Japan

2. Department of Gastroenterological Surgery, Fukuoka University, Fukuoka, Japan

3. Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan

4. Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan

5. Department of Surgery 1, University of Occupational and Environmental Health, Kitakyushu, Japan

6. Department of Gastroenterological Surgery and Oncology, Kitano Hospital Medical Research Institute, Osaka, Japan

7. Department of Gastroenterological Surgery, New Tokyo Hospital, Matsudo, Japan

8. Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Japan

9. Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan

10. Department of Surgery, Koseikai Takeda Hospital, Kyoto, Japan

11. Department of Surgery, Institute of Gastroenterology, Tokyo Woman’s Medical University, Tokyo, Japan

12. Department of Gastrointestinal Surgery, Kyoto University, Kyoto, Japan

13. Department of Surgery, Toyooka Hospital, Toyooka, Japan

14. Department of Surgery, Japanese Red Cross Otsu Hospital, Otsu, Japan

Abstract

Objective: This study aimed to evaluate the effect of continuing preoperative aspirin monotherapy on surgical outcomes in patients receiving antiplatelet therapy (APT). Summary Background Data: The effectiveness of continuing preoperative aspirin monotherapy in patients undergoing APT in preventing thromboembolic consequences is mostly unknown. Methods: This prospective multicenter cohort study on the Safety and Feasibility of Gastroenterological Surgery in Patients Undergoing Antithrombotic Therapy (GSATT study) conducted at 14 clinical centers enrolled and screened patients between October 2019 and December 2021. The participants (n=1,170) were assigned to the continued APT group, discontinued APT group, or non-APT group, and the surgical outcomes of each group were compared. Propensity score matching was performed between the continued and discontinued APT groups to investigate the effect of continuing preoperative aspirin therapy on thromboembolic complications. Results: The rate of thromboembolic complications in the continued APT group was substantially lower than that in the non-APT or discontinued APT groups (0.5% vs. 2.6% vs. 2.9%; P=0.027). Multivariate investigation of the entire cohort revealed that discontinuation of APT (P<0.001) and chronic anticoagulant use (P<0.001) were independent risk factors for postoperative thromboembolism. The post-matching evaluation demonstrated that the rates of thromboembolic complications were significantly different between the continued and discontinued APT groups (0.6% vs. 3.3%; P=0.012). Conclusions: APT discontinuation following elective gastroenterological surgery increases the risk of thromboembolic consequences, whereas continuing preoperative aspirin greatly reduces this risk. The continuation of preoperative aspirin therapy in APT-received patients is considered one of the best alternatives for preventing thromboembolism during elective gastroenterological surgery.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery