Risk of Complications After Injection Laryngoplasty and Medialization Thyroplasty on Anticoagulation

Systemic anticoagulation (AC) and antiplatelet (AP) medications are commonly prescribed for various conditions. We assess complication rates after injection laryngoplasty (IL) and medialization thyroplasty (MT) in patients taking AC/AP perioperatively.

A retrospective cohort study was conducted using the TriNetX United States Collaborative Network database. Patients ≥18 years old who underwent MT between 2015-2023 were included. Patients taking AC/AP (aspirin, warfarin, apixaban, edoxaban, rivaroxaban, dabigatran, dipyridamole, ticagrelor, prasugrel, clopidogrel, cilostazol, dalteparin, enoxaparin) within 1month of the procedure were identified and compared to those not taking these medications. Whether AC/AP was held perioperatively could not be assessed due to limitations of the database. The cohorts were propensity score matched by age, sex, race, ethnicity, and comorbidities. Complications within 30days of IL/MT were compared with Odds Ratios.

For IL, each cohort included 4956 patients, and MT included 1157 patients. Patients on AC/AP had higher rates of airway compromise (IL: OR 1.34, 95% CI 1.16-1.55; MT: OR 1.61, 95% CI 1.12-2.31) and dysphagia (IL: OR 1.20, 95% CI 1.09-1.33; MT: OR 1.56, 95% CI 1.23-1.97) postoperatively. No significant differences were found in rates of repeat procedures, hemorrhage, hematoma, or infection. When stratifying by class of medication (AC, AP, aspirin), only the AC group remained statistically significant for airway compromise (IL: OR 1.67, 95% CI 1.29-2.15; MT: OR 2.38, 95% CI 1.61-3.50) and dysphagia (IL: OR 1.59, 95% CI 1.35-1.86; MT: OR 2.14, 95% CI 1.58-2.89).

Based on analysis of a large healthcare database, IL/MT performed in adult patients on AC is associated with higher rates of postoperative dysphagia and airway compromise but not postoperative hemorrhage/hematoma.

Level III.