Does Aspirin Administration Increase Perioperative Morbidity in Patients With Cardiac Stents Undergoing Spinal Surgery?

Cuéllar, Jason M.; Petrizzo, Anthony; Vaswani, Ravi; Goldstein, Jeffrey A.; Bendo, John A.

doi:10.1097/brs.0000000000000695

Cited by 51 publications

(44 citation statements)

References 23 publications

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“…An observational study of patients undergoing elective pancreatic surgery also demonstrated that aspirin continuation in the perioperative period was not associated with increased rates of bleeding, transfusions or procedural complications, corroborating the findings of the present study and demonstrating the safety of aspirin in other surgical procedures [26]. A small study of patients with CAD and prior stents undergoing spine surgery also reported that perioperative aspirin administration appears to be safe [27]. …”

Section: Discussionsupporting

confidence: 85%

Perioperative antiplatelet therapy and cardiovascular outcomes in patients undergoing joint and spine surgery

Smilowitz

Oberweis

Nukala

et al. 2016

Journal of Clinical Anesthesia

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Study objective Perioperative thrombotic complications after orthopedic surgery are associated with significant morbidity and mortality. The use of aspirin to reduce perioperative cardiovascular complications in certain high-risk cohorts remains controversial. Few studies have addressed aspirin use, bleeding, and cardiovascular outcomes among high-risk patients undergoing joint and spine surgery. Design/setting/patients We performed a retrospective comparison of adults undergoing knee, hip, or spine surgery at a tertiary care center during 2 periods between November 2008 and December 2009 (reference period) and between April 2013 and December 2013 (contemporary period). Measurements Patient demographics, comorbidities, management, and outcomes were ascertained using hospital datasets. Main results A total of 5690 participants underwent 3075 joint and spine surgeries in the reference period and 2791 surgeries in the contemporary period. Mean age was 61 ± 13 years, and 59% were female. In the overall population, incidence of myocardial injury (3.1% vs 5.8%, P < .0001), hemorrhage (0.2% vs 0.8%, P = .0009), and red blood cell transfusion (17.2% vs 24.8%, P < .001) were lower in the contemporary period. Among 614 participants with a preoperative diagnosis of coronary artery disease (CAD), in-hospital aspirin use was significantly higher in the contemporary period (66% vs 30.7%, P < .0001); numerically, fewer participants developed myocardial injury (13.5% vs 19.3%, P = .05), had hemorrhage (0.3% vs 2.1%, P = .0009), and had red blood cell transfusion (37.2% vs 44.2%, P < .001) in the contemporary vs reference period. Conclusions In a large tertiary care center, the incidence of perioperative bleeding and cardiovascular events decreased over time. In participants with CAD, perioperative aspirin use increased and appears to be safe.

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Section: Discussionsupporting

confidence: 85%

Perioperative antiplatelet therapy and cardiovascular outcomes in patients undergoing joint and spine surgery

Smilowitz

Oberweis

Nukala

et al. 2016

Journal of Clinical Anesthesia

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“…Due to its role in anti-platelet aggregation, the use of aspirin may interfere with normal coagulation function during the perioperative period. However, discontinuation of aspirin before surgery remains controversial[52,53]. We recommend discontinuation of aspirin 7-10 d prior to elective surgery in order to avoid the increased risk of surgery-related bleeding, given that the lifespan of platelets is reported to be 7 to 10 d[54].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic experience of 289 elderly patients with biliary diseases

Zhang

Liu

et al. 2017

WJG

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AIMTo present clinical characteristics, diagnosis and treatment strategies in elderly patients with biliary diseases.METHODSA total of 289 elderly patients with biliary diseases were enrolled in this study. The clinical data relating to these patients were collected in our hospital from June 2013 to May 2016. Patient age, disease type, coexisting diseases, laboratory examinations, surgical methods, postoperative complications and therapeutic outcomes were analyzed.RESULTSThe average age of the 289 patients with biliary diseases was 73.9 ± 8.5 years (range, 60-102 years). One hundred and thirty-one patients (45.3%) had one of 10 different biliary diseases, such as gallbladder stones, common bile duct stones, and cholangiocarcinoma. The remaining patients (54.7%) had two types of biliary diseases. One hundred and seventy-nine patients underwent 9 different surgical treatments, including pancreaticoduodenectomy, radical resection of hilar cholangiocarcinoma and laparoscopic cholecystectomy. Ten postoperative complications occurred with an incidence of 39.3% (68/173), and hypopotassemia showed the highest incidence (33.8%, 23/68). One hundred and sixteen patients underwent non-surgical treatments, including anti-infection, symptomatic and supportive treatments. The cure rate was 97.1% (168/173) in the surgical group and 87.1% (101/116) in the non-surgical group. The difference between these two groups was statistically significant (χ2 = 17.227, P < 0.05).CONCLUSIONActive treatment of coexisting diseases, management of indications and surgical opportunities, appropriate selection of surgical procedures, improvements in perioperative therapy, and timely management of postoperative complications are key factors in enhancing therapeutic efficacy in elderly patients with biliary diseases.

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“…Antiplatelet drugs have been regarded to increase the risk of POSEH and most spinal surgeons have been reluctant to operate on patients taking them 1). However, a more recent study by Cuellar et al2) has reported there was no appreciable increase in bleeding-related complication rates in patients with cardiac stents undergoing spine surgeries while continuing to take aspirin compared with patients who discontinued aspirin prior to surgery. On the contrary, there was a case report suggesting hypercoagulability as a risk factor 16).…”

Section: Discussionmentioning

confidence: 99%

“…Many surgeons are reluctant to use antiplatelet drugs perioperatively under the assumption that bleeding tendency and hypocoagulability would increase the risk of POSEH 1). Most previous studies on risk factors for spinal epidural hematomas have focused on the bleeding tendency; however, they have failed to demonstrate it as a risk factor at least for POSEH 2). POSEHs are considered different from spontaneous and post-epidural catheterization hematomas because of the application of suction drains in most spine surgeries.…”

mentioning

confidence: 99%

Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

Ahn¹,

Shin²,

Kim³

et al. 2016

Clin Orthop Surg

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BackgroundPostoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability.MethodsThis was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15.ResultsThe remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs. 17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application.ConclusionsWith a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombin-containing local hemostatics and the length of time elapsed before the commencement of suction resulted in hypercoagulability, indicating these two factors could be causes of POSEH.

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Does Aspirin Administration Increase Perioperative Morbidity in Patients With Cardiac Stents Undergoing Spinal Surgery?

Abstract: 2.

Cited by 51 publications

References 23 publications

Perioperative antiplatelet therapy and cardiovascular outcomes in patients undergoing joint and spine surgery

Perioperative antiplatelet therapy and cardiovascular outcomes in patients undergoing joint and spine surgery

Therapeutic experience of 289 elderly patients with biliary diseases

Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

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