Effect of Antiplatelet Therapy on Patients Undergoing Gastroenterological Surgery: Thromboembolic Risks Versus Bleeding Risks During Its Perioperative Withdrawal

Abstract

Satisfactory outcomes were obtained during gastroenterologic surgery under rigorous perioperative management, including single-agent APT continuation in patients at high thromboembolic risk. Patients treated with multidrug APT still represent a challenging group, however, and need to be carefully managed to prevent perioperative complications.

Does Antiplatelet Therapy Affect Short-Term and Long-Term Outcomes of Patients Undergoing Surgery for Colorectal Cancer? - Surgical Radicality Versus Perioperative Antiplatelet-Related Morbidity Risks

“…Although 5-year OS rates in APT group appeared to be lower than those of non-APT group, statistical analysis suggested that the reduced OS rates largely resulted from severe underlying disease including heart failure or cardiovascular disease, and were not related to APT. be performed safely and satisfactorily in patients with APT [8,9] . In addition, the current study also showed that the Kokura Protocol is valid and feasible even in the setting of colorectal cancer surgery, resulting in neither increased perioperative complications nor decreased DFS/OS of colorectal cancer patients receiving APT.…”

“…We have established our own perioperative protocol ("Kokura Protocol") about antithrombotic agents and risk stratification using several guidelines concerning antithrombotics as references [8,9] . The perioperative management of antiplatelet agents is shown in Figure 1.…”

“…In patients with APT, perioperative risks of bleeding complications related to APT and thromboembolic complications associated with interruption of APT are major concerns [3][4][5][6][7][8] . We have shown that using perioperative antithrombotic management protocol ("Kokura Protocol"), both open and laparoscopic abdominal surgery can be performed safely and satisfactorily in patients with APT [8,9] . However, the effect of APT on both short-term and long-term outcomes in patients receiving surgeries for malignancy still remains largely unknown.…”

“…Due to the limitation of study evidence, however, the effect of APT on surgical outcome in patients receiving surgery for malignancy still remains largely unknown. Some recent reports showed favorable shortterm outcomes of surgical procedures on patients with APT [8,9,[21][22][23][24][25][26] . Nevertheless, there are no specific reports relating to the effect of APT on both short-term and long-term outcome after surgery for malignancy.…”

How Should Hilar Cholangiocarcinoma Be Treated In Patients Starting Dual Antiplatelet Therapy Just After Implantation Of Drug-Eluting Coronary Stents?

“…This case serves as an example of successful resolution of this challenging problem. in high thromboembolic risk patients ("Kokura Protocol") [2,3] , DAPT was discontinued 7 days prior to surgery and aspirin monotherapy was continued until surgery to minimize the risks of intraoperative bleeding and thromboembolic complications. We carried out left hepatectomy with Spiegel lobe resection, followed by biliary reconstruction ( Figure 1C).…”