1
|
Fujikawa T, Takahashi R. Impact of Antithrombotic Therapy on the Outcome of Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Systematic Literature Review. Cureus 2022; 14:e23390. [PMID: 35481301 PMCID: PMC9033526 DOI: 10.7759/cureus.23390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/07/2022] Open
Abstract
In recent years, many operations have been performed as laparoscopic surgeries in the field of gastrointestinal surgery, but the effect of antithrombotic therapy (ATT) on hemorrhagic complications in patients who have undergone laparoscopic colorectal cancer surgery remains unknown. In addition, the efficacy and safety of pharmacotherapy for the prevention of venous thromboembolism (VTE) have not yet been concluded. The purpose of this systematic review study is to clarify the effect of ATT on hemorrhagic complications in patients undergoing laparoscopic colorectal cancer surgery. Articles published between 2013 and 2020 were searched on Google Scholar and PubMed, and research regarding ATT and laparoscopic colorectal cancer surgery was included after a thorough examination of each study. Each study yielded information on the study's design, type of surgical procedures, antithrombotic medications used, and surgical outcomes (both thromboembolic and hemorrhagic consequences). This systematic review comprised 20 published papers, including a total of 12,751 patients who received laparoscopic colorectal cancer surgery. Four studies on thrombosis prevention in VTE were randomized clinical trials, and the other 16 were cohort or case-control studies. For the effects of prolonged use of ATT on hemorrhagic complications, most studies demonstrated that laparoscopic colorectal cancer surgery with continued preoperative aspirin could be safely conducted without an increase in the frequency of bleeding complications. On the other hand, most included papers have shown that patients receiving VTE pharmacoprophylaxis may be at an increased risk of bleeding complications, but its effectiveness has not been statistically proven, especially in the Asian patient population. Laparoscopic colorectal cancer surgery in patients on prolonged ATT can be safely conducted with no increase in the incidence of hemorrhagic or thrombotic complications. The efficacy and safety of VTE pharmacoprophylaxis in laparoscopic colorectal surgery is still at issue. It is necessary to establish available protocols or guidelines by validating reliable studies.
Collapse
|
2
|
Abe S, Ami K, Katsuno A, Tamura N, Harada T, Hamasaki S, Kitagawa Y, Machida T, Umetani N. Emergency gastrointestinal surgery in patients undergoing antithrombotic therapy in a single general hospital: a propensity score-matched analysis. BMC Gastroenterol 2021; 21:323. [PMID: 34418977 PMCID: PMC8380394 DOI: 10.1186/s12876-021-01897-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
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.
Collapse
Affiliation(s)
- Shinya Abe
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3 Kitaasagaya, Suginami-ku, Tokyo, 166-0001, Japan.
| | - Katsunori Ami
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3 Kitaasagaya, Suginami-ku, Tokyo, 166-0001, Japan
| | - Akira Katsuno
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3 Kitaasagaya, Suginami-ku, Tokyo, 166-0001, Japan
| | - Noriyasu Tamura
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3 Kitaasagaya, Suginami-ku, Tokyo, 166-0001, Japan
| | - Toshiko Harada
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3 Kitaasagaya, Suginami-ku, Tokyo, 166-0001, Japan
| | - Shunsuke Hamasaki
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3 Kitaasagaya, Suginami-ku, Tokyo, 166-0001, Japan
| | - Yusuke Kitagawa
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3 Kitaasagaya, Suginami-ku, Tokyo, 166-0001, Japan
| | - Taku Machida
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3 Kitaasagaya, Suginami-ku, Tokyo, 166-0001, Japan
| | - Naoyuki Umetani
- Department of Digestive Surgery, Kawakita General Hospital, 1-7-3 Kitaasagaya, Suginami-ku, Tokyo, 166-0001, Japan
| |
Collapse
|