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Antithrombotic drugs do not increase intraoperative blood loss in emergency gastrointestinal surgery: a
Tadashi Matsuoka1,2, Kenji Kobayashi1, Alan Kawarai Lefor3
11Department of Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
Insights
Antithrombotic drugs do not increase intraoperative blood loss during emergency gastrointestinal surgery. Patients on these medications can safely undergo urgent procedures without increased bleeding risk.
Area of Science:
- Gastroenterology
- Cardiology
- Surgery
Background:
- Antithrombotic drug use is rising due to an aging population.
- Discontinuation of antithrombotics before elective surgery is standard practice.
- Emergency surgery in patients on antithrombotics poses a risk of bleeding due to unattenuated drug effects.
Purpose of the Study:
- To investigate if antithrombotic agents increase intraoperative blood loss in emergency gastrointestinal surgery.
- To assess the safety of emergency gastrointestinal surgery in patients taking antithrombotic drugs.
Main Methods:
- Retrospective review of emergency abdominal surgery patients (January 2013 - December 2017).
- Primary outcome: intraoperative blood loss.
- 1:1 propensity score matching analysis comparing antithrombotic drug users and a control group.
Main Results:
- 117 matched pairs (170 patients on antithrombotics) were analyzed.
- No significant difference in intraoperative blood loss between the antithrombotic group and the control group (p=0.43).
- Median blood loss: 60 ml (IQR 225-10) vs 100 ml (IQR 243-10).
Conclusions:
- Antithrombotic drugs do not elevate intraoperative blood loss in emergency gastrointestinal surgery.
- Emergency gastrointestinal surgery can be safely performed in patients taking antithrombotic agents.
- Antithrombotic drug use should not be a reason to postpone necessary emergency surgical interventions.
Background:
The use of antithrombotic drugs is increasing with the aging population. Prior to elective procedures, antithrombotic drugs are often discontinued. For emergency procedures in patients taking antithrombotic drugs, their effect cannot be attenuated which may lead to an increased risk of hemorrhagic events. However, there are few studies showing increased intraoperative blood loss in patients taking antithrombotic drugs who undergo emergency gastrointestinal surgery. The aim of this study is to determine whether the use of antithrombotic agents increases intraoperative blood loss in emergency gastrointestinal surgery.
Methods:
A retrospective review of patients who underwent emergency abdominal surgery between January 2013 and December 2017 was conducted. The primary outcome measure was intraoperative blood loss. Patients were divided into the antithrombotic drug group and a control group, and a propensity score was developed using multivariate logistic regression. We use 1:1 propensity score matching analysis to compare outcomes between the two groups.
Results:
Of 1555 patients included in this study, 1184 patients, including 170 patients taking antithrombotic drugs, were eligible for propensity score matching analysis. A 1:1 matching yielded 117 well-balanced pairs. There was no statistically significant difference in intraoperative blood loss (antithrombotic drug group vs control group, median (interquartile): 60 (225-10) vs 100 (243-10) ml, p = 0.43).
Conclusions:
This study suggests that antithrombotic drugs do not increase intraoperative blood loss in patients undergoing emergency gastrointestinal surgery. Emergency gastrointestinal surgery for patients currently taking antithrombotic drugs can be performed safely, and the use of antithrombotic drugs is not a reason to delay surgical intervention.
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