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Endoscopic sinus surgery in patients receiving anticoagulant or antiplatelet therapy

Zoukaa Sargi1, Roy Casiano

  • 1Department of Otolaryngology, University of Miami-Leonard Miller School of Medicine, Miami, Florida, USA. zsargi@med.miami.edu

American Journal of Rhinology
|July 12, 2007
PubMed

Insights

Endoscopic sinus surgery (ESS) is safe for patients on anticoagulation or antiplatelet therapy. Stopping medication before surgery is necessary, but resuming it early postoperatively does not increase bleeding risk.

Area of Science:

  • Otolaryngology
  • Surgical Safety
  • Pharmacology

Background:

  • Endoscopic sinus surgery (ESS) safety in patients on anticoagulant or antiplatelet therapy remains unstudied.
  • Accurate bleeding risk classification for ESS is crucial for perioperative management of these therapies.

Purpose of the Study:

  • To evaluate the safety and bleeding risk of ESS in patients undergoing anticoagulant or antiplatelet therapy.
  • To determine optimal perioperative management strategies for these medications during ESS.

Main Methods:

  • Retrospective case-control study utilizing prospectively collected data.
  • Comparison of 42 patients on anticoagulant therapy undergoing ESS with 42 matched controls.
  • Data collected from an academic tertiary referral center.

Main Results:

  • No statistically significant difference in estimated blood loss (EBL) between groups.
  • Increased EBL correlated with the number of sinuses opened (p=0.001).
  • No major postoperative bleeding events related to anticoagulation were reported; all patients resumed their therapies.

Conclusions:

  • ESS can be safely performed in patients on anticoagulation or antiplatelet therapy, categorized as a moderate bleeding risk procedure.
  • Medication cessation before surgery is mandatory, but early postoperative resumption is feasible without increased bleeding risk.
  • Perioperative heparin bridging should be based on individual patient risk, not the procedure itself.
Abstract

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