Comparison of perioperative continuation or discontinuation of antithrombotic drugs in elective inguinal hernia repair surgery: a systematic review and meta-analysis

Objective: This article aims to summarize the most recent and comprehensive pooled analyses and evidence updates to study and analyze the efficacy and safety of continued antithrombotic medications during the perioperative period of elective inguinal hernia repair. Design: Systematic review and meta-analysis. Data sources: As of January 2025, we performed a systematic literature search using PubMed, Embase, and Web of Science. The safety and efficacy of continuing or discontinuing antithrombotic medications in the perioperative period of elective inguinal hernia repair were compared. Outcomes included operative time, post-operative pain scores, intraoperative blood loss, deaths, length of stay (LOS), reoperation, readmission, cardiovascular-related events, time to return to normal activity, lower extremity venous thrombosis, urinary retention, wound infection, and seroma. Results: A total of 14 studies were included, involving 4096 patients (1172 patients who continued antithrombotic versus 2924 patients who stopped antithrombotic therapy). There were no statistically significant differences between the two groups in terms of gender, age, hernia defect size, and unilateral or bilateral hernias, except for higher American Society of Anesthesiologists scores, body mass index, and cardiovascular disease rates in the continued application group. Combined analysis showed no significant differences between the two groups in terms of operative time, intraoperative blood loss, number of deaths, LOS, reoperations, readmissions, cardiovascular-related events, lower extremity venous thrombosis, urinary retention, and wound infections, except for the continued application group, which had a longer postoperative recovery time and a higher incidence of postoperative seroma. Conclusions: Our study suggests that, under the current paradigm of perioperative management, there is no need to discontinue antithrombotic drugs in the perioperative period of elective inguinal hernia repair after adequate assessment of the patient’s risk of bleeding. These recommendations are guidelines only; the needs of individual patients may require a different approach. Of course, these conclusions are mainly drawn from observational data and thus need to be verified in larger-scale, higher-quality randomized controlled studies in the future.