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Continued Antiplatelet Therapy and Risk of Bleeding in Gastrointestinal Procedures: A Systematic Review
Xiao Fang1, Jacques G Baillargeon1, Daniel C Jupiter1
1Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX.
Insights
For patients undergoing gastrointestinal surgery, continuing antiplatelet therapy does not significantly increase bleeding risk. This systematic review found no significant difference in bleeding complications for those on continuous aspirin or clopidogrel therapy.
Area of Science:
- Gastroenterology
- Cardiology
- Surgical Oncology
Background:
- Managing perioperative antiplatelet medications in gastrointestinal (GI) surgery presents challenges due to bleeding risks.
- Discontinuing antiplatelet therapy can be dangerous for patients with cardiovascular conditions.
- This review addresses the dilemma of balancing bleeding risk against the necessity of antiplatelet therapy in GI surgery.
Purpose of the Study:
- To systematically review and compare bleeding risks in GI surgery patients on continuous antiplatelet therapy versus those not on such therapy.
- To evaluate the safety of continuing aspirin, clopidogrel, or dual antiplatelet therapy during GI procedures.
Main Methods:
- A systematic review of studies published between January 2000 and July 2015 was conducted.
- Searches were performed in Medline Ovid and CINAHL databases using keywords related to antiplatelet drugs, bleeding, and GI surgery.
- Study quality was assessed using the Newcastle-Ottawa score or Cochrane Collaboration's tool.
Main Results:
- Twenty-two studies were included in the review.
- Five studies indicated a higher risk of intraoperative or postoperative bleeding in patients on continuous antiplatelet therapy.
- Seventeen studies found no statistically significant difference in bleeding risks between groups.
Conclusions:
- The risk of bleeding during GI procedures for patients on antiplatelet therapy is not significantly elevated compared to those with no or interrupted therapy.
- Continuing antiplatelet medication may be a safe option for select GI surgery patients.
- Further research may refine guidelines for managing antiplatelet therapy in this population.
Background:
Management of perioperative antiplatelet medications in gastrointestinal (GI) surgery is challenging. The risk of intraoperative and postoperative bleeding is associated with perioperative use of antiplatelet medication. However, cessation of these drugs may be unsafe for patients who are required to maintain antiplatelet use due to cardiovascular conditions. The objective of this systematic review was to compare the risk of intraoperative or postoperative bleeding among patients who had GI surgery while on continuous antiplatelet therapy (aspirin, clopidogrel, or dual therapy) with the risk among those not taking continuous antiplatelet medication.
Study Design:
We reviewed articles published between January 2000 and July 2015 from the Medline Ovid and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Studies involving any GI procedures were included if the articles met our inclusion criteria (listed in Methods). The following key words were used for the search: clopidogrel, Plavix, aspirin, antiplatelet, bleeding, hemorrhage, and digestive system surgical procedures. Quality of the studies was assessed, depending on their study design, using the Newcastle-Ottawa score or the Cochrane Collaboration's tool for assessing risk of bias.
Results:
Twenty-two studies were eligible for inclusion in the systematic review. Five showed that the risk of intraoperative bleeding or postoperative bleeding among patients who had GI surgery while on continuous antiplatelet therapy was higher compared that for those not on continuous therapy. The remaining 17 studies reported that there was no statistically significant difference in the risks of bleeding between the continuous antiplatelet therapy group and the group without continuous antiplatelet therapy.
Conclusions:
The risk of bleeding associated with GI procedures in patients receiving antiplatelet therapy was not significantly higher than in patients with no antiplatelet or interrupted antiplatelet therapy.
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