Effect of Aspirin Continuation on Blood Loss and Postoperative Morbidity in Patients Undergoing Laparoscopic Cholecystectomy or Colorectal Cancer Resection

Abstract

No consensus exists whether to continue or withdraw aspirin therapy perioperatively in patients undergoing major laparoscopic abdominal surgery. To investigate whether preoperative continuation of aspirin therapy increases blood loss and associated morbidity during laparoscopic cholecystectomy and colorectal cancer resection, we compared duration of surgical procedures, amount of intraoperative blood loss, rate of blood transfusion, length of postoperative stay, rate of conversion to open surgery, and reoperation within 48 hours between patients with and without aspirin therapy preoperatively. Twenty-nine of 270 patients who underwent laparoscopic cholecystectomy and 23 of 218 patients who underwent laparoscopic colorectal cancer resection, respectively, were on aspirin therapy. We found no significant difference in the investigated outcome between groups with the exception of longer surgical duration of laparoscopic cholecystectomy in aspirin-treated patients. Although underpowered, above findings may suggest that aspirin continuation is unlikely to increase blood loss or postoperative morbidity in patients undergoing laparoscopic cholecystectomy or colorectal cancer resection.

Colorectal cancer in the world: incidence, mortality and risk factors

“…Moreover, the fecal fat level increases after cholecystectomy (Goldacre et al, 2005). Constant colon exposure to high levels of metabolic products such as bile acids, non-digestible fat, and other end-products of colonic micro flora (like methylindole and zuccato) can lead to an increased risk of CRC (Ono et al, 2013).…”

Safety and feasibility of liver resection with continued antiplatelet therapy using aspirin

“…In pancreatectomy, thoracoscopic surgery, and laparoscopic abdominal surgery, several investigators have reported the necessity of continuing aspirin in patients who take aspirin for the secondary prevention of cardiovascular diseases . Three randomized control trials have investigated the incidence of major thrombotic and hemorrhagic morbidity between aspirin and placebo groups .…”

“…Recent clinical guidelines recommend that clinicians should evaluate and decide whether to continue aspirin on an individual basis, according to the balance between the risk of occlusive cardiovascular events and the risk of major bleeding events . Several investigators have reported the safety of continuing anti‐platelet therapy using aspirin during the perioperative period . However, many institutions still suspend aspirin administration before surgery .…”

Current Status in the Treatment of Acute Cholecystitis Patients Receiving Antithrombotic Therapy: Is Endoscopic Drainage Feasible?- A Systematic Review

“…Research article collection and screening were conducted from January 2019 to February 2019. A total of 8 studies on surgical cholecystectomy (mainly LC), [11][12][13][14][15][16][17][18] 3 studies on PTGBD, [19][20][21] and 1 study on EGBD 5 in patients receiving ATT were selected for data extraction and satisfied our inclusion criteria. As only 1 study on EGBD in patients receiving ATT was retrieved through the search method mentioned above, articles were additionally searched using the keywords "ETGBD" and "EUS-GBD".…”

“…In the 12 studies that evaluated surgery and gallbladder drainage, patients receiving ATT, including aspirin and/or thienopyridine, were the focus of 3 studies. 12,14,15 Only 1 study evaluated patients receiving anticoagulant therapy with heparin bridging, 11 1 study evaluated patients receiving anticoagulant therapy and/or with coagulopathy, 19 and the other studies 5,13,[16][17][18]20,21 evaluated patients receiving antiplatelet agents and/or anticoagulants during surgery (LC or OC) or internal drainage (PTGBD or EGBD) without discontinuation of ATT (Table 1).…”