Key result
Antithrombotic therapy did not significantly increase estimated blood loss or postoperative complications in patients undergoing emergency gastrointestinal surgery, although anticoagulant use was an independent risk factor for severe intraoperative bleeding (OR 6.50).
Why the study?
Emergency surgeries in patients on antithrombotic therapy are increasing, but the effect on intraoperative blood loss and perioperative complications remains unclear.
Does antithrombotic therapy increase intraoperative severe blood loss and postoperative complications in patients undergoing emergency gastrointestinal surgery?
Cohort (n=732)
No
Does antithrombotic therapy increase intraoperative severe blood loss and postoperative complications in patients undergoing emergency gastrointestinal surgery?
Absolute Event Rate: 27% vs 25%
p-value: p=0.676
Antithrombotic therapy does not adversely affect overall perioperative outcomes in emergency gastrointestinal surgery, although anticoagulant use independently increases the risk of severe intraoperative bleeding.
Effect of antithrombotic therapy on bleeding in emergency GI surgery remains unclear; leaves open optimal perioperative strategies.
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) were assessed. The optimal value of EBL was determined using the receiver operating characteristic curve. 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 ≥ 113 ml) occurred 3 in 146 patients. Multivariate analysis using the full cohort revealed that anticoagulant drug use was an independent risk factor for severe bleeding (odds ratio, 6.50; 95% CI 1.4-36; p = 0.015). Conclusions: This study demonstrated antithrombotic drugs do not adversely affect the perioperative outcomes of emergency gastrointestinal surgery, although patients taking anticoagulant drugs or multiple antithrombotic drugs should undergo careful surgical performances and postoperative management.
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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 Postoperative complications (Clavien-Dindo grade II or greater) (p=0.676). Antithrombotic therapy did not significantly increase estimated blood loss or postoperative complications in patients undergoing emergency gastrointestinal surgery, although anticoagulant use was an independent risk factor for severe intraoperative bleeding (OR 6.50).
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