Postoperative Bleeding Complications after Gastric Cancer Surgery in Patients Receiving Anticoagulation and/or Antiplatelet Agents

Mita, Kazuhito; Ito, Hideto; Murabayashi, Ryo; Sueyoshi, Kouichirou; Asakawa, Hideki; Nabetani, Masashi; Kamasako, Akira; Koizumi, Kazuya; Hayashi, Takashi

doi:10.1245/s10434-012-2500-6

Cited by 49 publications

(36 citation statements)

References 28 publications

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“…The risk of nonfatal postoperative major bleeding secondary to chemoprophylaxis is a matter of debate, with several studies reporting conflicting results. 1,26–29 Mita et al 30 reported a higher rate of postoperative bleeding after gastric cancer surgery among patients receiving chemoprophylaxis (8.1 %) compared with no chemoprophylaxis (0.7 %). In contrast, Reddy et al 14 reported that VTE chemoprophylaxis did not increase the rate of red blood cell transfusion after major hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy

Ejaz

Spolverato

Kim

et al. 2014

Journal of Gastrointestinal Surgery

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Background The incidence of venous thromboembolism (VTE) among patients undergoing hepatic surgery is poorly defined, leading to varied use of VTE prophylaxis among surgeons. We sought to define the incidence of VTE after liver surgery and identify risk factors associated with VTE. Methods Incidence of VTE and associated risk factors within 90 days of hepatic resection between 2006 and 2012 at a major academic center was analyzed. Risk factors for VTE were identified using univariate and multivariate analyses. Results A total of 599 patients were included in the study cohort; 30 (5.0 %) had a prior history of VTE. The indications for surgery were malignant (90.8 %) and benign lesions (9.2 %). The majority of patients underwent a minor hepatectomy (<3 Couinaud segments; n =402, 67.1 %) while 195 (32.6 %) patients underwent a major hepatectomy (≥3 Couinaud segments). Three hundred seven (51.3 %) patients were started on VTE chemoprophylaxis preoperatively with 407 (67.8 %) patients receiving VTE chemoprophylaxis within 24 h of surgery. Twenty-eight (4.7 %) patients developed VTE; 20 (3.3 %) had deep venous thrombosis (DVT), 11 (1.8 %) had pulmonary embolism (PE), and three (0.5 %) developed both DVTand PE. Among the VTE patients, 23 (82.1 %) had received VTE chemoprophylaxis. On multivariate analyses, history of VTE (odds ratio [OR] 4.51, 95 % confidence interval [CI] 1.81–17.22, P =0.03), prolonged operative time (OR 1.17 per additional hour, 95 % CI 1.04–1.32, P =0.009), and increased length of stay (LOS) (OR 1.07, 95 % CI 1.02–1.12, P =0.01) were independent risk factors for VTE. Conclusion VTE within 90 days of hepatic resection is common, occurring in nearly one in 20 patients. Most VTE events occurred among patients who received current best practice prophylaxis for VTE. More aggressive strategies to identify and reduce the risk of VTE in patients at highest risk of VTE, including those with a history of VTE, extended operative time, and prolonged LOS, are warranted.

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Section: Discussionmentioning

confidence: 99%

Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy

Ejaz

Spolverato

Kim

et al. 2014

Journal of Gastrointestinal Surgery

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“…Bulky bleeding is a wasting complication and is specific related to extended or super extended lymphadenectomy and may occurs in 0.6-3.6% (30). Luminal bleeding often originates from anastomosis sites and will not need any aggressive therapy.…”

Section: Hemorrhagementioning

confidence: 99%

Management of postoperative complications of lymphadenectomy

Barchi¹,

Charruf²,

Oliveira³

et al. 2016

Transl. Gastroenterol. Hepatol.

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Gastric cancer remains a disease with poor prognosis, mainly due to its late diagnosis. Surgery remains as the only treatment with curative intent, where the goal is radical resection with free-margin gastrectomy and extended lymphadenectomy. Over the last two decades there has been an improvement on postoperative outcomes. However, complications rate is still not negligible even in high volume specialized centers and are directly related mainly to the type of gastric resection: total or subtotal, combined with adjacent organs resection and the extension of lymphadenectomy (D1, D2 and D3). The aim of this study is to analyze the complications specific-related to lymphadenectomy in gastric cancer surgery.

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“…The risk of developing hemorrhagic complications during or after surgery in patients with ATT remains uncertain. While several studies have reported the increasing risk of perioperative hemorrhagic complications with ATT [1][2][3], the safety and feasibility of surgery for patients with continuous aspirin therapy have also been reported recently in two randomized clinical trials regarding non-cardiac surgery [4,5] and several retrospective studies regarding abdominal surgery [6][7][8]. Chassot et al [9] recommend continuing aspirin preoperatively when prescribed as secondary prevention or cardiovascular disease or stroke because the risk of cardiovascular events when withdrawing them is generally higher than the risk of surgical bleeding.…”

Section: Introductionmentioning

confidence: 99%

Effect of antithrombic therapy on bleeding complications in patients receiving emergency cholecystectomy for acute cholecystitis

Kawamoto

Fujikawa

Sakamoto

et al. 2018

J Hepato Biliary Pancreat

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Background The risk of developing hemorrhagic complications during or after emergency cholecystectomy in patients with antithrombic therapy (ATT) remains uncertain. In this study, we evaluate outcomes in patients with ATT undergoing emergency cholecystectomy and assess the relevance between ATT and perioperative complications including bleeding complications. Methods We retrospectively evaluated 296 patients who were diagnosed as acute cholecystitis and underwent emergency cholecystectomy between 2005 and 2017. One hundred and thirty‐three of them (45%) were on ATT. The primary outcome measures were intraoperative blood loss over 500 ml and postoperative complications including bleeding complications. This study was approved by our institutional review board (#13072904). Results There were 23 patients (8%) who experienced intraoperative blood loss over 500 ml and nine postoperative bleeding complications (3%). Multivariable analyses showed that male sex (P = 0.027), Performance Status 2–4 (P = 0.031) and grade II or III acute cholecystitis (P = 0.033) were independent risk factors for intraoperative bleeding over 500 ml, whereas not single antiplatelet therapy (APT) use but multiple APT (P = 0.034) and anticoagulation therapy (ACT) (P = 0.032) were independently associated with postoperative bleeding complications. Additionally, laparoscopic surgery, but not ATT, was a significant prognostic factor for severe postoperative complications. Conclusions Single APT was not remained as an independently associated factor of intraoperative excessive bleeding or severe postoperative complications including bleeding complications. However, patients treated with multiple APT or ACT still represent a challenging group and must be carefully managed to avoid postoperative bleeding complications.

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Postoperative Bleeding Complications after Gastric Cancer Surgery in Patients Receiving Anticoagulation and/or Antiplatelet Agents

Abstract: Perioperative antithrombotic treatment is an independent risk factor of postoperative bleeding complications in patients with gastric cancer undergoing radical gastrectomy, although such treatment was effective in preventing postoperative thromboembolic events.

Cited by 49 publications

References 28 publications

Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy

Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy

Management of postoperative complications of lymphadenectomy

Effect of antithrombic therapy on bleeding complications in patients receiving emergency cholecystectomy for acute cholecystitis

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