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

Monden, Kazuteru; Shinmoto, Hiroshi; Hioki, Mika; Ohno, Satoshi; Saneto, Hiromi; Ueki, Toru; Yabushita, Kazuhisa; Ono, Kazumi; Sakaguchi, Kousaku; Takakura, Norihisa

doi:10.1002/jhbp.461

Cited by 13 publications

(12 citation statements)

References 30 publications

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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: 98%

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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Section: Introductionmentioning

confidence: 98%

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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“…To prevent ischemic or thromboembolic events in patients with the indication of AP therapy, the application of antiplatelet therapies is rapidly increasing, especially considering the aging of population [11][12][13]. Therefore, a clinical dispute arises that whether patients with both primary ICH and the indication of AP therapy should resume AP therapy [14].…”

Section: Introductionmentioning

confidence: 99%

“…Because of the risk of ICH recurrence, primary ICH is usually considered as contraindication of AP therapy [14]. However, without AP therapy, many patients may suffer from ischemic and thromboembolic events.…”

Section: Introductionmentioning

confidence: 99%

Resumption of antiplatelet therapy in patients with primary intracranial hemorrhage-benefits and risks: A meta-analysis of cohort studies

Ding

Liu

Tan

et al. 2018

Journal of the Neurological Sciences

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“…In the current study, using PSM analysis to alleviate statistical bias, the safety of preoperative aspirin continuation during liver resection was also demonstrated. The recent study conducted by Monden et al 19 showed that bleeding-related complication did not increase during or after liver resection in patients receiving continued aspirin. However, the number of cases in their study was small, and there were significant differences in patients' background.…”

Section: Discussionmentioning

confidence: 93%

Impact of preoperative aspirin continuation on bleeding complications during or after liver resection: Propensity score‐matched analysis

Naito

Fujikawa

Hasegawa

2020

J Hepato Biliary Pancreat

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Background: There is insufficient evidence concerning the effect of preoperative continuation of antiplatelet therapy (APT) on intraoperative and postoperative bleeding during liver resection. This study investigated the efficacy and safety of preoperative aspirin continuation on bleeding complications during or after liver resection using propensity score matching (PSM). Methods: Between 2005 and 2018, 425 patients who underwent liver resection were enrolled in this study. Patients were divided into two groups; the cAPT group received continued aspirin monotherapy preoperatively (n = 63) and the control group did not (n = 362). Propensity score matching was performed based on the preoperative clinical parameters. Intraoperative and postoperative complications, including bleeding complications, were compared between groups. Results: After propensity score matching, 126 patients were included in the analysis (cAPT group, n = 63 and control group, n = 63). There were no differences in patients' background characteristics, and intraoperative blood loss was identical between the groups (200 vs 180 mL, P = .54). The frequency of postoperative complications (Clavien-Dindo class 2 or higher, 13/63 [20.6%] vs 13/63 [20.6%], P = 1.00) and postoperative hemorrhagic complication (3/63 [4.8%] vs 3/63 [4.8%], P = 1.00) was also similar between the groups; no difference was observed in the length of postoperative stay (11 days vs 14 days, P = .08). Conclusion: Preoperative continuation of aspirin monotherapy does not affect intraoperative or postoperative bleeding in patients receiving liver resection. Either open or laparoscopic liver resection can be safely performed in patients with continued aspirin therapy.

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

Abstract: Liver resection can be safely performed while continuing aspirin therapy without increasing hemorrhagic morbidity. Our results suggest that interruption of aspirin therapy is unnecessary for patients undergoing liver resection.

Cited by 13 publications

References 30 publications

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

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

Resumption of antiplatelet therapy in patients with primary intracranial hemorrhage-benefits and risks: A meta-analysis of cohort studies

Impact of preoperative aspirin continuation on bleeding complications during or after liver resection: Propensity score‐matched analysis

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