Effect of Antiplatelet Therapy on Patients Undergoing Gastroenterological Surgery: Thromboembolic Risks Versus Bleeding Risks During Its Perioperative Withdrawal
Background Antiplatelet agents given to prevent thromboembolic disease are frequently withdrawn prior to surgical procedures to reduce bleeding complications. This action may expose patients to increased thromboembolic morbidity and mortality. Methods A series of 2012 patients who had undergone gast...
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| Veröffentlicht in: | World journal of surgery 2015-01, Vol.39 (1), p.139-149 |
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| creator | Fujikawa, Takahisa Tanaka, Akira Abe, Toshihiro Yoshimoto, Yasunori Tada, Seiichiro Maekawa, Hisatsugu |
| description | Background
Antiplatelet agents given to prevent thromboembolic disease are frequently withdrawn prior to surgical procedures to reduce bleeding complications. This action may expose patients to increased thromboembolic morbidity and mortality.
Methods
A series of 2012 patients who had undergone gastroenterologic surgery between January 2005 and June 2010 at our institution were reviewed. Among this cohort, antiplatelet therapy (APT) was used in 519 patients (25.8 %). The perioperative management included interruption of APT 1 week before surgery and early postoperative reinstitution in patients at low thromboembolic risk, although APT was maintained until surgery in those at high thromboembolic risk. Bleeding and thromboembolic complications, as well as other outcome variables, were assessed in patients with and without APT.
Results
Among 519 patients with APT, 99 (19.1 %) underwent multidrug APT. Among them, 124 (23.9 %) required preoperative continuation of APT. None suffered from excessive bleeding intraoperatively. There were 19 thromboembolic events (0.9 %) in the whole cohort. Postoperative bleeding complications occurred in 37 patients (1.8 %). Multivariate analysis showed that increased postoperative bleeding complications were independently associated with multidrug APT [hazard ratio (HR) 4.3,
p
= 0.014], high-risk surgical procedures (HR 3.5,
p
= 0.003), and perioperative heparin bridging (HR 2.8,
p
= 0.029). High-risk surgery (HR 8.3,
p
|
| doi_str_mv | 10.1007/s00268-014-2760-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1639978044</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3533266651</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4884-2af304cbfe1d133e535d89559b82644989cde8e5d97ee4cdf2b701ef7fb41ab13</originalsourceid><addsrcrecordid>eNqFkd9v1SAcxYlxcdfpH-CLIfHFlzp-taW-bXObM0tc3OYeCW2_3DG5pQPqcv8c_1NpOo0xMT4QAnzO4cBB6BUl7ygh9X4khFWyIFQUrK5IwZ-gFRWcFYwz_hStCK_yCad8Fz2P8Y4QmqnqGdplJcuiqlmhH8fGQJewN_hgSHZ0OoGDhK9uIehxi_2AL3SyMKSIr4cewtrbYY1PdUzB510I3vm17bTDl1NYQ9i-z9rgN62HPJzt8Bcbv0X8FUKcIj50AP3ssOx-mMK8OMvuFxCsH_OtyX4HfGPTbR_0g3Yv0I7RLsLLx3kPXZ8cXx19LM4_n54dHZwXnZAyP1MbTkTXGqA95RxKXvayKcumlawSopFN14OEsm9qANH1hrU1oWBq0wqqW8r30NvFdwz-foKY1MbGDpzTA_gpKlrxpqklESKjb_5C7_wUhpxupqQsa86qTNGF6oKPMYBRY7AbHbaKEjX3p5b-VK5Czf0pnjWvH52ndgP9b8WvwjLQLMCDdbD9v6O6-XR5eEJqWs6x2aKN4_zrEP6I_c9EPwFtBbnZ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1638857326</pqid></control><display><type>article</type><title>Effect of Antiplatelet Therapy on Patients Undergoing Gastroenterological Surgery: Thromboembolic Risks Versus Bleeding Risks During Its Perioperative Withdrawal</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Springer Nature - Complete Springer Journals</source><creator>Fujikawa, Takahisa ; Tanaka, Akira ; Abe, Toshihiro ; Yoshimoto, Yasunori ; Tada, Seiichiro ; Maekawa, Hisatsugu</creator><creatorcontrib>Fujikawa, Takahisa ; Tanaka, Akira ; Abe, Toshihiro ; Yoshimoto, Yasunori ; Tada, Seiichiro ; Maekawa, Hisatsugu</creatorcontrib><description>Background
Antiplatelet agents given to prevent thromboembolic disease are frequently withdrawn prior to surgical procedures to reduce bleeding complications. This action may expose patients to increased thromboembolic morbidity and mortality.
Methods
A series of 2012 patients who had undergone gastroenterologic surgery between January 2005 and June 2010 at our institution were reviewed. Among this cohort, antiplatelet therapy (APT) was used in 519 patients (25.8 %). The perioperative management included interruption of APT 1 week before surgery and early postoperative reinstitution in patients at low thromboembolic risk, although APT was maintained until surgery in those at high thromboembolic risk. Bleeding and thromboembolic complications, as well as other outcome variables, were assessed in patients with and without APT.
Results
Among 519 patients with APT, 99 (19.1 %) underwent multidrug APT. Among them, 124 (23.9 %) required preoperative continuation of APT. None suffered from excessive bleeding intraoperatively. There were 19 thromboembolic events (0.9 %) in the whole cohort. Postoperative bleeding complications occurred in 37 patients (1.8 %). Multivariate analysis showed that increased postoperative bleeding complications were independently associated with multidrug APT [hazard ratio (HR) 4.3,
p
= 0.014], high-risk surgical procedures (HR 3.5,
p
= 0.003), and perioperative heparin bridging (HR 2.8,
p
= 0.029). High-risk surgery (HR 8.3,
p
< 0.001) and poor performance status (HR 4.9,
p
= 0.005)—but neither APT nor anticoagulation use—were significant prognostic factors for thromboembolic complications.
Conclusions
Satisfactory outcomes were obtained during gastroenterologic surgery under rigorous perioperative management, including single-agent APT continuation in patients at high thromboembolic risk. Patients treated with multidrug APT still represent a challenging group, however, and need to be carefully managed to prevent perioperative complications.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-014-2760-3</identifier><identifier>PMID: 25201469</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Abdominal Surgery ; Abdominal Wall Hematoma ; Adult ; Aged ; Bleeding Complication ; Cardiac Surgery ; Digestive System Surgical Procedures - statistics & numerical data ; Esophagectomy ; Female ; Gastrectomy ; General Surgery ; High Thromboembolic Risk ; Humans ; Incidence ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Multivariate Analysis ; Original Scientific Report ; Platelet Aggregation Inhibitors - therapeutic use ; Postoperative Bleeding Complication ; Postoperative Complications - prevention & control ; Postoperative Hemorrhage - etiology ; Postoperative Hemorrhage - prevention & control ; Prognosis ; Retrospective Studies ; Surgery ; Thoracic Surgery ; Thromboembolic Complication ; Thromboembolism - prevention & control ; Vascular Surgery</subject><ispartof>World journal of surgery, 2015-01, Vol.39 (1), p.139-149</ispartof><rights>Société Internationale de Chirurgie 2014</rights><rights>2015 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>Société Internationale de Chirurgie 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4884-2af304cbfe1d133e535d89559b82644989cde8e5d97ee4cdf2b701ef7fb41ab13</citedby><cites>FETCH-LOGICAL-c4884-2af304cbfe1d133e535d89559b82644989cde8e5d97ee4cdf2b701ef7fb41ab13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-014-2760-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-014-2760-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,41469,42538,45555,45556,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25201469$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fujikawa, Takahisa</creatorcontrib><creatorcontrib>Tanaka, Akira</creatorcontrib><creatorcontrib>Abe, Toshihiro</creatorcontrib><creatorcontrib>Yoshimoto, Yasunori</creatorcontrib><creatorcontrib>Tada, Seiichiro</creatorcontrib><creatorcontrib>Maekawa, Hisatsugu</creatorcontrib><title>Effect of Antiplatelet Therapy on Patients Undergoing Gastroenterological Surgery: Thromboembolic Risks Versus Bleeding Risks During Its Perioperative Withdrawal</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
Antiplatelet agents given to prevent thromboembolic disease are frequently withdrawn prior to surgical procedures to reduce bleeding complications. This action may expose patients to increased thromboembolic morbidity and mortality.
Methods
A series of 2012 patients who had undergone gastroenterologic surgery between January 2005 and June 2010 at our institution were reviewed. Among this cohort, antiplatelet therapy (APT) was used in 519 patients (25.8 %). The perioperative management included interruption of APT 1 week before surgery and early postoperative reinstitution in patients at low thromboembolic risk, although APT was maintained until surgery in those at high thromboembolic risk. Bleeding and thromboembolic complications, as well as other outcome variables, were assessed in patients with and without APT.
Results
Among 519 patients with APT, 99 (19.1 %) underwent multidrug APT. Among them, 124 (23.9 %) required preoperative continuation of APT. None suffered from excessive bleeding intraoperatively. There were 19 thromboembolic events (0.9 %) in the whole cohort. Postoperative bleeding complications occurred in 37 patients (1.8 %). Multivariate analysis showed that increased postoperative bleeding complications were independently associated with multidrug APT [hazard ratio (HR) 4.3,
p
= 0.014], high-risk surgical procedures (HR 3.5,
p
= 0.003), and perioperative heparin bridging (HR 2.8,
p
= 0.029). High-risk surgery (HR 8.3,
p
< 0.001) and poor performance status (HR 4.9,
p
= 0.005)—but neither APT nor anticoagulation use—were significant prognostic factors for thromboembolic complications.
Conclusions
Satisfactory outcomes were obtained during gastroenterologic surgery under rigorous perioperative management, including single-agent APT continuation in patients at high thromboembolic risk. Patients treated with multidrug APT still represent a challenging group, however, and need to be carefully managed to prevent perioperative complications.</description><subject>Abdominal Surgery</subject><subject>Abdominal Wall Hematoma</subject><subject>Adult</subject><subject>Aged</subject><subject>Bleeding Complication</subject><subject>Cardiac Surgery</subject><subject>Digestive System Surgical Procedures - statistics & numerical data</subject><subject>Esophagectomy</subject><subject>Female</subject><subject>Gastrectomy</subject><subject>General Surgery</subject><subject>High Thromboembolic Risk</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Original Scientific Report</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Postoperative Bleeding Complication</subject><subject>Postoperative Complications - prevention & control</subject><subject>Postoperative Hemorrhage - etiology</subject><subject>Postoperative Hemorrhage - prevention & control</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Thromboembolic Complication</subject><subject>Thromboembolism - prevention & control</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkd9v1SAcxYlxcdfpH-CLIfHFlzp-taW-bXObM0tc3OYeCW2_3DG5pQPqcv8c_1NpOo0xMT4QAnzO4cBB6BUl7ygh9X4khFWyIFQUrK5IwZ-gFRWcFYwz_hStCK_yCad8Fz2P8Y4QmqnqGdplJcuiqlmhH8fGQJewN_hgSHZ0OoGDhK9uIehxi_2AL3SyMKSIr4cewtrbYY1PdUzB510I3vm17bTDl1NYQ9i-z9rgN62HPJzt8Bcbv0X8FUKcIj50AP3ssOx-mMK8OMvuFxCsH_OtyX4HfGPTbR_0g3Yv0I7RLsLLx3kPXZ8cXx19LM4_n54dHZwXnZAyP1MbTkTXGqA95RxKXvayKcumlawSopFN14OEsm9qANH1hrU1oWBq0wqqW8r30NvFdwz-foKY1MbGDpzTA_gpKlrxpqklESKjb_5C7_wUhpxupqQsa86qTNGF6oKPMYBRY7AbHbaKEjX3p5b-VK5Czf0pnjWvH52ndgP9b8WvwjLQLMCDdbD9v6O6-XR5eEJqWs6x2aKN4_zrEP6I_c9EPwFtBbnZ</recordid><startdate>201501</startdate><enddate>201501</enddate><creator>Fujikawa, Takahisa</creator><creator>Tanaka, Akira</creator><creator>Abe, Toshihiro</creator><creator>Yoshimoto, Yasunori</creator><creator>Tada, Seiichiro</creator><creator>Maekawa, Hisatsugu</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>201501</creationdate><title>Effect of Antiplatelet Therapy on Patients Undergoing Gastroenterological Surgery: Thromboembolic Risks Versus Bleeding Risks During Its Perioperative Withdrawal</title><author>Fujikawa, Takahisa ; Tanaka, Akira ; Abe, Toshihiro ; Yoshimoto, Yasunori ; Tada, Seiichiro ; Maekawa, Hisatsugu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4884-2af304cbfe1d133e535d89559b82644989cde8e5d97ee4cdf2b701ef7fb41ab13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Abdominal Surgery</topic><topic>Abdominal Wall Hematoma</topic><topic>Adult</topic><topic>Aged</topic><topic>Bleeding Complication</topic><topic>Cardiac Surgery</topic><topic>Digestive System Surgical Procedures - statistics & numerical data</topic><topic>Esophagectomy</topic><topic>Female</topic><topic>Gastrectomy</topic><topic>General Surgery</topic><topic>High Thromboembolic Risk</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Original Scientific Report</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Postoperative Bleeding Complication</topic><topic>Postoperative Complications - prevention & control</topic><topic>Postoperative Hemorrhage - etiology</topic><topic>Postoperative Hemorrhage - prevention & control</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Thromboembolic Complication</topic><topic>Thromboembolism - prevention & control</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fujikawa, Takahisa</creatorcontrib><creatorcontrib>Tanaka, Akira</creatorcontrib><creatorcontrib>Abe, Toshihiro</creatorcontrib><creatorcontrib>Yoshimoto, Yasunori</creatorcontrib><creatorcontrib>Tada, Seiichiro</creatorcontrib><creatorcontrib>Maekawa, Hisatsugu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fujikawa, Takahisa</au><au>Tanaka, Akira</au><au>Abe, Toshihiro</au><au>Yoshimoto, Yasunori</au><au>Tada, Seiichiro</au><au>Maekawa, Hisatsugu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Antiplatelet Therapy on Patients Undergoing Gastroenterological Surgery: Thromboembolic Risks Versus Bleeding Risks During Its Perioperative Withdrawal</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2015-01</date><risdate>2015</risdate><volume>39</volume><issue>1</issue><spage>139</spage><epage>149</epage><pages>139-149</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
Antiplatelet agents given to prevent thromboembolic disease are frequently withdrawn prior to surgical procedures to reduce bleeding complications. This action may expose patients to increased thromboembolic morbidity and mortality.
Methods
A series of 2012 patients who had undergone gastroenterologic surgery between January 2005 and June 2010 at our institution were reviewed. Among this cohort, antiplatelet therapy (APT) was used in 519 patients (25.8 %). The perioperative management included interruption of APT 1 week before surgery and early postoperative reinstitution in patients at low thromboembolic risk, although APT was maintained until surgery in those at high thromboembolic risk. Bleeding and thromboembolic complications, as well as other outcome variables, were assessed in patients with and without APT.
Results
Among 519 patients with APT, 99 (19.1 %) underwent multidrug APT. Among them, 124 (23.9 %) required preoperative continuation of APT. None suffered from excessive bleeding intraoperatively. There were 19 thromboembolic events (0.9 %) in the whole cohort. Postoperative bleeding complications occurred in 37 patients (1.8 %). Multivariate analysis showed that increased postoperative bleeding complications were independently associated with multidrug APT [hazard ratio (HR) 4.3,
p
= 0.014], high-risk surgical procedures (HR 3.5,
p
= 0.003), and perioperative heparin bridging (HR 2.8,
p
= 0.029). High-risk surgery (HR 8.3,
p
< 0.001) and poor performance status (HR 4.9,
p
= 0.005)—but neither APT nor anticoagulation use—were significant prognostic factors for thromboembolic complications.
Conclusions
Satisfactory outcomes were obtained during gastroenterologic surgery under rigorous perioperative management, including single-agent APT continuation in patients at high thromboembolic risk. Patients treated with multidrug APT still represent a challenging group, however, and need to be carefully managed to prevent perioperative complications.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>25201469</pmid><doi>10.1007/s00268-014-2760-3</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0364-2313 |
| ispartof | World journal of surgery, 2015-01, Vol.39 (1), p.139-149 |
| issn | 0364-2313 1432-2323 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Springer Nature - Complete Springer Journals |
| subjects | Abdominal Surgery Abdominal Wall Hematoma Adult Aged Bleeding Complication Cardiac Surgery Digestive System Surgical Procedures - statistics & numerical data Esophagectomy Female Gastrectomy General Surgery High Thromboembolic Risk Humans Incidence Male Medicine Medicine & Public Health Middle Aged Multivariate Analysis Original Scientific Report Platelet Aggregation Inhibitors - therapeutic use Postoperative Bleeding Complication Postoperative Complications - prevention & control Postoperative Hemorrhage - etiology Postoperative Hemorrhage - prevention & control Prognosis Retrospective Studies Surgery Thoracic Surgery Thromboembolic Complication Thromboembolism - prevention & control Vascular Surgery |
| title | Effect of Antiplatelet Therapy on Patients Undergoing Gastroenterological Surgery: Thromboembolic Risks Versus Bleeding Risks During Its Perioperative Withdrawal |
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