Outcomes of Antithrombotic Therapy in Patients Undergoing Gastrointestinal Surgery: A Meta-Analysis

Antithrombotic therapy is commonly prescribed for the prevention and management of thromboembolic diseases but poses significant challenges in the perioperative setting of gastrointestinal (GI) surgery due to the competing risks of bleeding and thrombosis. This meta-analysis aimed to evaluate the clinical outcomes associated with perioperative antithrombotic therapy in patients undergoing GI surgery. A systematic search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, ProQuest, and Google Scholar, following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Nine studies comprising 13,107 patients were included. The primary outcomes assessed were postoperative bleeding, thromboembolic events, and blood transfusion requirements. Statistical analysis was performed using a DerSimonian-Laird random-effects model, and outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). The pooled analysis showed a non-significant trend toward increased postoperative bleeding in patients on antithrombotic therapy (OR: 1.64, 95% CI: 0.98-2.75, p = 0.061). Thromboembolic events did not differ significantly between groups (OR: 0.91, 95% CI: 0.41-2.04, p = 0.82), with low heterogeneity (I² = 0%). However, transfusion requirements were significantly higher in the antithrombotic group (OR: 2.87, 95% CI: 1.19-6.95, p = 0.019), indicating an increased need for intraoperative or postoperative blood products. While continuation of aspirin monotherapy appeared relatively safe in elective settings, dual antiplatelet therapy and direct oral anticoagulants (DOACs) were associated with greater bleeding risks, particularly in complex or minimally invasive procedures. These findings suggest that with careful patient selection and perioperative planning, antithrombotic therapy can often be safely managed during GI surgery. However, individualized risk assessment remains critical to minimize adverse outcomes. Further randomized controlled trials are needed to establish clear guidelines for antithrombotic management in this surgical population.