Key result
Continuing antiplatelet therapy in colorectal surgery was not significantly associated with postoperative bleeding (OR 2.65, 95% CI 0.78-8.99) or thrombotic events (OR 0.29, 95% CI 0.06-1.32).
Why the study?
Perioperative management of antiplatelet therapy in colorectal surgery requires balancing surgical bleeding risk against cardiovascular and cerebrovascular complications from treatment withdrawal, prompting an assessment of continuing versus discontinuing therapy preoperatively.
Does perioperative continuation of antiplatelet therapy affect postoperative bleeding and thrombotic events compared with preoperative discontinuation in adults undergoing colorectal surgery?
Meta-Analysis (n=505)
Does perioperative continuation of antiplatelet therapy affect postoperative bleeding and thrombotic events compared with preoperative discontinuation in adults undergoing colorectal surgery?
Answers are grounded in this paper and cite their sources.
In established antiplatelet users undergoing colorectal surgery, perioperative continuation showed no statistically significant difference in bleeding or thrombotic events compared with discontinuation, though very low certainty of evidence requires individualized risk management.
Background: Perioperative management of antiplatelet therapy in colorectal surgery requires balancing the risk of surgical bleeding against cardiovascular and cerebrovascular complications after treatment withdrawal. This meta-analysis assessed the safety of continuing antiplatelet therapy compared with preoperative discontinuation. Methods: PubMed and Embase were searched through 30 May 2026 for comparative studies of adults undergoing colorectal surgery. Random-effects models were used to pool odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes. The clinically relevant analysis was restricted to patients already receiving antiplatelet therapy with separately reported continuation and discontinuation groups. Risk of bias was assessed with ROBINS-I and certainty of evidence with GRADE. Results: Seven observational studies were included in the systematic review, of which four (505 patients; 209 continuation and 296 discontinuation) contributed to the primary analysis. Continuation was not associated with statistically significant differences in postoperative bleeding (OR 2.65, 95% CI 0.78–8.99), thrombotic events (OR 0.29, 95% CI 0.06–1.32), transfusion (OR 1.39, 95% CI 0.35–5.51), overall morbidity (OR 2.08, 95% CI 0.97–4.48), intraoperative blood loss (MD −2.74 mL, 95% CI −13.07 to 7.59), or operative time (MD 0.72 min, 95% CI −11.83 to 13.27). Hospital stay was longer with continuation (MD 0.65 days, 95% CI 0.40–0.91). In the broader secondary analysis, continuation was associated with increased postoperative bleeding (OR 3.30, 95% CI 1.40–7.78). GRADE certainty was very low for all outcomes. Conclusions: Among established antiplatelet users undergoing colorectal surgery, continuation was not associated with statistically significant differences in bleeding or thrombotic outcomes compared with discontinuation. However, sparse events, imprecise estimates, and very low certainty of evidence preclude definitive safety conclusions. Perioperative management should be individualized according to thrombotic risk, anticipated bleeding risk, and surgical complexity.
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Morărașu et al. (2026) conducted a meta-analysis in Colorectal surgery in patients receiving antiplatelet therapy (n=505). Perioperative continuation of antiplatelet therapy vs. Preoperative discontinuation of antiplatelet therapy was evaluated on Postoperative bleeding (OR 2.65, 95% CI 0.78-8.99). Continuing antiplatelet therapy in colorectal surgery was not significantly associated with postoperative bleeding (OR 2.65, 95% CI 0.78-8.99) or thrombotic events (OR 0.29, 95% CI 0.06-1.32).
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