Perioperative Antithrombotic Treatment in Proctological Surgery

Background: This retrospective study attempted to identify the optimal perioperative antithrombotic treatment regimen for proctological surgery. Methods: From April 2008 to August 2014, 529 patients (351 males and 178 females) underwent proctological surgery. Of these 529 patients, 73 (13.8%) received preoperative antithrombotic treatment. Perioperatively, antithrombotic treatment was unchanged for 26 patients, switched to heparin for 38 patients, and withdrawn for 9 patients. Results: Postoperative hemorrhage occurred in 18 of the 529 patients (3.4%). No uncontrolled intraoperative bleeding was reported, and there were no intraoperative deaths. The incidence of postoperative hemorrhage was 1/26 (3.8%) in the antithrombotic drug continuation group, 14/38 (36.8%) in the heparin substitution group, 0/9 (0%) in the antithrombotic treatment discontinuation group, and 3/456 (0.7%) in the control group. The risk factors for hemorrhage were heparin substitution (p < 0.001; 95% confidence interval 14.557-166.588; odds ratio 49.241) and operative time (p = 0.050; 95% confidence interval 1.000-1.025; odds ratio 1.013). Conclusions: The incidence of thromboembolism caused by preoperative discontinuation of antithrombotic treatment was very low; however, thromboembolism can result in serious complications. Heparin substitution was associated with the highest incidence of postoperative hemorrhage; thus, continuation of existing antithrombotic treatment appears to be a safer perioperative antithrombotic strategy for proctological surgery.