Perioperative Management of Antithrombotic Therapy in Gynecologic Surgery: A Retrospective Study

Aim: To evaluate perioperative antithrombotic management strategies and their effects on hemoglobin change and postoperative outcomes in women undergoing gynecologic surgery. Methods: This retrospective study included women aged ≥18 years who underwent gynecologic surgery while receiving long-term antithrombotic therapy between December 2022 and December 2024. Patients were categorized according to perioperative management strategies, including continuation, temporary interruption, or bridging. The primary outcome was perioperative hemoglobin change and the need for blood transfusion. Secondary outcomes included thromboembolic events, surgical complications, and intensive care unit admission. Statistical analysis was performed using nonparametric and categorical tests, with a significance threshold of p < 0.05. Results: Seventy-three women were included. The mean age was 59.5 years, and obesity and hypertension were common. Most surgeries were classified as high bleeding risk. Hemoglobin values were available for 59 patients. Hemoglobin decrease ranged from minimal change in the bridging group to greater declines in those with prolonged interruption, but no statistically significant difference was identified among management strategies. Postoperative complications occurred in 9.6% of patients, including one pulmonary embolism. Three patients required transfusion, and no major cardiovascular events were observed. Conclusions: Different perioperative antithrombotic strategies were not associated with statistically significant differences in blood loss or postoperative complications; however, these findings should be interpreted cautiously given the limited sample size and subgroup distribution. The results should be considered hypothesis-generating rather than definitive, and individualized decision-making based on thromboembolic and bleeding risk remains essential in gynecologic surgery.