Antithrombotic drugs do not increase intraoperative blood loss in emergency gastrointestinal surgery: a single-instituti
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(2019) 14:63
RESEARCH ARTICLE
Open Access
Antithrombotic drugs do not increase intraoperative blood loss in emergency gastrointestinal surgery: a single-institution propensity score analysis Tadashi Matsuoka1,2* , Kenji Kobayashi1, Alan Kawarai Lefor3, Junichi Sasaki2 and Hiroharu Shinozaki1
Abstract Background: The use of antithrombotic drugs is increasing with the aging population. Prior to elective procedures, antithrombotic drugs are often discontinued. For emergency procedures in patients taking antithrombotic drugs, their effect cannot be attenuated which may lead to an increased risk of hemorrhagic events. However, there are few studies showing increased intraoperative blood loss in patients taking antithrombotic drugs who undergo emergency gastrointestinal surgery. The aim of this study is to determine whether the use of antithrombotic agents increases intraoperative blood loss in emergency gastrointestinal surgery. Methods: A retrospective review of patients who underwent emergency abdominal surgery between January 2013 and December 2017 was conducted. The primary outcome measure was intraoperative blood loss. Patients were divided into the antithrombotic drug group and a control group, and a propensity score was developed using multivariate logistic regression. We use 1:1 propensity score matching analysis to compare outcomes between the two groups. Results: Of 1555 patients included in this study, 1184 patients, including 170 patients taking antithrombotic drugs, were eligible for propensity score matching analysis. A 1:1 matching yielded 117 well-balanced pairs. There was no statistically significant difference in intraoperative blood loss (antithrombotic drug group vs control group, median (interquartile): 60 (225–10) vs 100 (243–10) ml, p = 0.43). Conclusions: This study suggests that antithrombotic drugs do not increase intraoperative blood loss in patients undergoing emergency gastrointestinal surgery. Emergency gastrointestinal surgery for patients currently taking antithrombotic drugs can be performed safely, and the use of antithrombotic drugs is not a reason to delay surgical intervention. Keywords: Emergency gastrointestinal surgery, Antithrombotic drug, Intraoperative blood loss
Background Antithrombotic drugs have important prophylactic and therapeutic effects for patients with various diseases such as coronary artery disease [1], atrial fibrillation [2], cerebrovascular disease [3], and peripheral vascular disease [4]. These beneficial effects have been confirmed in * Correspondence: [email protected] 1 Department of Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan 2 Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan Full list of author information is available at the end of the article
many studies [5–8]. However, these medications can lead to bleeding which is an adverse effect [9, 10]. They increase the risk of cerebral hemorrhage [10] and gastrointestinal bleeding [11]. There are no agents to rapidly reverse th
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