Key result
Antithrombotic therapy was not an independent risk factor for severe intraoperative bleeding (OR 1.08) or postoperative bleeding complications in patients undergoing emergency gastrointestinal surgery.
Why the study?
Emergency surgeries in patients on antithrombotic therapy are increasing, but the effect of antithrombotic therapy on intraoperative blood loss and perioperative complications remains unclear.
Does antithrombotic therapy increase intraoperative severe blood loss and postoperative bleeding complications in patients undergoing emergency gastrointestinal surgery?
Cohort (n=732)
No
Does antithrombotic therapy increase intraoperative severe blood loss and postoperative bleeding complications in patients undergoing emergency gastrointestinal surgery?
Odds Ratio: 1.08 (95% CI 0.05–7.83)
Absolute Event Rate: 10.9% vs 5.5%
p-value: p=0.947
Antithrombotic therapy does not adversely affect perioperative outcomes, including severe blood loss and bleeding complications, in patients undergoing emergency gastrointestinal surgery.
AT use showed no excess bleeding risk in emergency GI surgery; supports safety hypothesis but leaves open need for prospective validation.
BACKGROUND: This study aimed to review and evaluate the surgical outcomes, particularly intraoperative severe blood loss and postoperative blood complications, of emergency gastrointestinal surgery in patients undergoing antithrombotic therapy (AT). Emergency surgeries for patients with antithrombotic medication have been increasing in the aging population. However, the effect of AT on intraoperative blood loss and perioperative complications remains unclear. METHODS: We retrospectively reviewed 732 patients who underwent emergency gastrointestinal surgery between April 2014 and March 2019. Patients were classified into AT group and Non-AT group, and propensity score-matched analysis was performed to compare the short surgical outcomes between the groups. Additionally, risk factors in severe estimated blood loss (EBL) and postoperative bleeding complications were assessed. RESULTS: Altogether, 64 patients received AT; 50 patients and 12, and 2 were given antiplatelet and anticoagulant, and both drugs, respectively. After propensity score matching, EBL (101 vs. 99 mL; p = 0.466) and postoperative complications (14 vs. 16 patients; p = 0.676) were similar between the groups (63 patients matched paired). Intraoperative severe bleeding (EBL ≥ 492 mL) occurred in 44 patients. Multivariate analysis using the full cohort revealed that antithrombotic drug use was not an independent risk factor for severe bleeding and postoperative bleeding complications. CONCLUSIONS: This study demonstrated antithrombotic drugs do not adversely affect the perioperative outcomes of emergency gastrointestinal surgery.
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Abe et al. (2021) conducted a cohort in Critical digestive disorders requiring emergency gastrointestinal surgery (n=732). Antithrombotic therapy vs. No antithrombotic therapy was evaluated on Severe intraoperative bleeding (estimated blood loss ≥ 492 mL) (OR 1.08, 95% CI 0.05-7.83, p=0.947). Antithrombotic therapy was not an independent risk factor for severe intraoperative bleeding (OR 1.08) or postoperative bleeding complications in patients undergoing emergency gastrointestinal surgery.
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