Aspirin Does Not Increase the Need for Hemostatic Interventions in Blunt Liver and Spleen Injuries.

Abstract

Background: The prohemorrhagic effect of aspirin may cause concern about worse prognoses when treating blunt hepatic or splenic injuries. This study investigated whether preinjury aspirin yields an increasing need for hemostatic interventions.Methods: Admission and outpatient records were extracted from the Taiwan National Health Insurance Research Database (NHIRD) from 2003 to 2015. Patients with splenic or hepatic injuries were identified. Patients with preinjury nonaspirin APAC or with penetrating injuries were excluded. The primary outcome measurement was the necessity of invasive procedures to stop bleeding, including transarterial embolization (TAE) and surgeries. One-to-two propensity score matching (PSM) was used to minimize selection bias. Multilogistic regression (MLR) analysis was used to identify factors associated with hemostatic interventions.Results: 20,470 (60.6%) had blunt hepatic injuries, and 15,235 (45.1%) had blunt splenic injuries, of whom 691 (3.4%) and 667 (4.4%) used preinjury aspirin, respectively. In the blunt hepatic injury cohort, there was no significant difference in the need for hemostatic procedures (TAE (6.1% vs 6.1%, p=1.000), exploratory laparotomy (6.1% vs 6.1%, p=1.000), hepatectomy (3.0% vs 2.7%, p=0.694) or hepatorrhaphy (14.3% vs 15.0%, p=0.681)). MLR analysis showed that preinjury aspirin did not increase the need for hemostatic interventions (OR 0.92, 95% CI 0.73-1.16, p=0.473). Regarding the blunt splenic injury cohort, there was no significant difference in the need for hemostatic procedures (TAE (11.5% vs 10.6%, p=0.547), splenectomy (43.5% vs 41.4%, p=0.407) or splenorrhaphy (3.0% vs 3.3%, p=0.698)). An MLR analysis showed that preinjury aspirin did not increase the need for hemostatic interventions (OR 1.12, 95% CI 0.91-1.38, p=0.290).Conclusions: Preinjury aspirin use is not associated with increased hemostatic procedures in blunt hepatic or splenic injuries.