Emergency gastrointestinal surgery in patients undergoing antithrombotic therapy in a single general hospital: a propensity score-matched analysis

• Published in: BMC gastroenterology Vol. 21; no. 1; pp. 1 - 323
• Main Authors: Abe, Shinya, Ami, Katsunori, Katsuno, Akira, Tamura, Noriyasu, Harada, Toshiko, Hamasaki, Shunsuke, Kitagawa, Yusuke, Machida, Taku, Umetani, Naoyuki
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 21-08-2021; BioMed Central; BMC
• Subjects: Age; Aging; Anticoagulants; Antithrombotic therapy; Appendicitis; Bleeding; Blood; Blood transfusions; Cardiac arrhythmia; Comorbidity; Complications; Drugs; Emergency surgery; Gastroenterology; Gastrointestinal surgery; Gender; Hemoglobin; Hemorrhage; Hospitals; Laboratories; Laparoscopy; Laparotomy; Medical personnel; Multivariate analysis; Patient outcomes; Patients; Postoperative period; Propensity score matched analysis; Risk factors; Stroke; Surgery; Surgical emergencies; Surgical outcomes; Thrombolytic therapy; Japan
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-021-01897-0

Abstract
Background
This study aimed to review and evaluate the surgical outcomes, particularly intraoperative severe blood loss and postoperative blood complications, of emergency gastrointestinal surgery in patients undergoing antithrombotic therapy (AT). Emergency surgeries for patients with antithrombotic medication have been increasing in the aging population. However, the effect of AT on intraoperative blood loss and perioperative complications remains unclear.
Methods
We retrospectively reviewed 732 patients who underwent emergency gastrointestinal surgery between April 2014 and March 2019. Patients were classified into AT group and Non-AT group, and propensity score-matched analysis was performed to compare the short surgical outcomes between the groups. Additionally, risk factors in severe estimated blood loss (EBL) and postoperative bleeding complications were assessed.
Results
Altogether, 64 patients received AT; 50 patients and 12, and 2 were given antiplatelet and anticoagulant, and both drugs, respectively. After propensity score matching, EBL (101 vs. 99 mL;
p
 = 0.466) and postoperative complications (14 vs. 16 patients;
p
 = 0.676) were similar between the groups (63 patients matched paired). Intraoperative severe bleeding (EBL ≥ 492 mL) occurred in 44 patients. Multivariate analysis using the full cohort revealed that antithrombotic drug use was not an independent risk factor for severe bleeding and postoperative bleeding complications.
Conclusions
This study demonstrated antithrombotic drugs do not adversely affect the perioperative outcomes of emergency gastrointestinal surgery.