Effect of antithrombotic therapy on postoperative outcome of 538 consecutive emergency laparoscopic cholecystectomies for acute cholecystitis: two Italian center's study.
Acute cholecystitis
Anticoagulation therapy
Antiplatelet therapy
Antithrombotic therapy
Bleeding complication
Emergency cholecystectomy
Laparoscopy
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
17
12
2020
accepted:
01
02
2021
pubmed:
15
2
2021
medline:
16
10
2021
entrez:
14
2
2021
Statut:
ppublish
Résumé
The risk of developing hemorrhagic complications during or after emergency cholecystectomy (EC) for acute cholecystitis (AC) in patients with antithrombotic therapy (ATT) remains uncertain. In this double-center study, we evaluated post-operative outcomes in patients with ATT undergoing EC. We retrospectively evaluated 538 patients who underwent laparoscopic EC for AC between May 2015 and December 2019 at two referral centers. 89 of them (17%) were on ATT. We defined postoperative complication rates, including bleeding, as our primary outcome. Mortality was higher in the ATT group. Morbidity was higher in the ATT group as well; however, the difference was not statistically significant. 12 patients (2%) experienced intraoperative blood loss over 500 ml and ten (2%) had postoperative bleeding complications. Two patients (< 1%) experienced both intraoperative and postoperative bleeding. On multivariate analysis, ATT was not significantly associated with worse postoperative outcomes. Antithrombotic therapy is not an independently associated factor of severe postoperative complications (including bleeding) or mortality. However, these patients still represent a challenging group and must be carefully managed to avoid postoperative bleeding complications.
Identifiants
pubmed: 33582984
doi: 10.1007/s13304-021-00994-9
pii: 10.1007/s13304-021-00994-9
doi:
Substances chimiques
Fibrinolytic Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1767-1774Informations de copyright
© 2021. Italian Society of Surgery (SIC).
Références
Yetkin G, Uludag M, Oba S, Citgez B, Paksoy I (2009) Laparoscopic cholecystectomy in elderly patients. JSLS 13:587–591
doi: 10.4293/108680809X1258998404604
Tambyraja AL, Kumar S, Nixon SJ (2004) Outcome of laparoscopic cholecystectomy in patients 80 years and older. World J Surg 28:745–748
doi: 10.1007/s00268-004-7378-4
Mita K, Ito H, Murabayashi R, Sueyoshi K, Asakawa H, Nabetani M, Kamasako A, Koizumi K, Hayashi T (2012) Postoperative bleeding complications after gastric cancer surgery in patients receiving anticoagulation and/or antiplatelet agents. Ann Surg Oncol 19:3745–3752
doi: 10.1245/s10434-012-2500-6
Devereaux PJ, Mrkobrada M, Sessler DI, Leslie K, Alonso-Coello P, Kurz A, Villar JC, Sigamani A, Biccard BM, Meyhoff CS, Parlow JL, Guyatt G, Robinson A, Garg AX, Rodseth RN, Botto F, LuratiBuse G, Xavier D, Chan MT, Tiboni M, Cook D, Kumar PA, Forget P, Malaga G, Fleischmann E, Amir M, Eikelboom J, Mizera R, Torres D, Wang CY, VanHelder T, Paniagua P, Berwanger O, Srinathan S, Graham M, Pasin L, Le Manach Y, Gao P, Pogue J, Whitlock R, Lamy A, Kearon C, Baigent C, Chow C, Pettit S, Chrolavicius S, Yusuf S, POISE-2 Investigators (2014) Aspirin in patients undergoing noncardiac surgery. N Engl J Med 370:1494–1503
Mita K, Ito H, Takahashi K, Hashimoto M, Nagayasu K, Murabayashi R, Asakawa H, Koizumi K, Hayashi T, Fujino K (2016) Postpancreatectomy hemorrhage after pancreatic surgery in patients receiving anticoagulation or antiplatelet agents. Surg Innov 23:284–290
doi: 10.1177/1553350615618288
Oscarsson A, Gupta A, Fredrikson M, Jarhult J, Nystrom M, Pettersson E, Darvish B, Krook H, Swahn E, Eintrei C (2010) To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial. Br J Anaesth 104:305–312
doi: 10.1093/bja/aeq003
Mantz J, Samama CM, Tubach F, Devereaux PJ, Collet JP, Albaladejo P, Cholley B, Nizard R, Barré J, Piriou V, Poirier N, Mignon A, Schlumberger S, Longrois D, Aubrun F, Farèse ME, Ravaud P, Steg PG, Stratagem Study Group (2011) Impact of preoperative maintenance or interruption of aspirin on thrombotic and bleeding events after elective non-cardiac surgery: the multicentre, randomized, blinded, placebo-controlled, STRATAGEM Trial. Br J Anaesth 107:899–910
Fujikawa T, Tanaka A, Abe T, Yoshimoto Y, Tada S, Maekawa H, Shimoike N (2013) Does antiplatelet therapy affect outcomes of patients receiving abdominal laparoscopic surgery? Lessons from more than 1,000 laparoscopic operations in a single tertiary referral hospital. J Am Coll Surg 217:1044–1053
doi: 10.1016/j.jamcollsurg.2013.08.005
Fujikawa T, Tanaka A, Abe T, Yoshimoto Y, Tada S, Maekawa H (2015) Effect of antiplatelet therapy on patients undergoing gastroenterological surgery: thromboembolic risks versus bleeding risks during its perioperative withdrawal. World J Surg 39:139–149
doi: 10.1007/s00268-014-2760-3
Monden K, Sadamori H, Hioki M, Ohno S, Saneto H, Ueki T, Yabushita K, Sakaguchi K, Takakura N (2017) Safety and feasibility of liver resection with continued antiplatelet therapy using aspirin. J Hepatobiliary Pancreat Sci 24:375–381
doi: 10.1002/jhbp.461
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R (2012) Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:E326S-E350S
doi: 10.1378/chest.11-2298
Joseph B, Rawashdeh B, Aziz H, Kulvatunyou N, Pandit V, Jehangir Q, O’Keeffe T, Tang A, Green DJ, Friese RS, Rhee P (2015) An acute care surgery dilemma: emergent laparoscopic cholecystectomy in patients on aspirin therapy. Am J Surg 209:689–694
doi: 10.1016/j.amjsurg.2014.04.014
Akahoshi K, Ochiai T, Takaoka A, Kitamura T, Ban D, Kudo A, Tanaka S, Tanbe M (2017) Emergency cholecystectomy for patients on antiplatelet therapy. Am Surg 83:486–490
doi: 10.1177/000313481708300523
Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, Kozaka K, Endo I, Deziel DJ, Miura F, Okamoto K, Hwang TL, Huang WS, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Noguchi Y, Shikata S, Ukai T, Higuchi R, Gabata T, Mori Y, Iwashita Y, Hibi T, Jagannath P, Jonas E, Liau KH, Dervenis C, Gouma DJ, Cherqui D, Belli G, Garden OJ, Giménez ME, de Santibañes E, Suzuki K, Umezawa A, Supe AN, Pitt HA, Singh H, Chan ACW, Lau WY, Teoh AYB, Honda G, Sugioka A, Asai K, Gomi H, Itoi T, Kiriyama S, Yoshida M, Mayumi T, Matsumura N, Tokumura H, Kitano S, Hirata K, Inui K, Sumiyama Y, Yamamoto M (2018) Tokyo Guidelines 2018 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 25:41–54
doi: 10.1002/jhbp.515
Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Garden OJ, Kiriyama S, Hata J, Gabata T, Yoshida M, Miura F, Okamoto K, Tsuyuguchi T, Itoi T, Yamashita Y, Dervenis C, Chan AC, Lau WY, Supe AN, Belli G, Hilvano SC, Liau KH, Kim MH, Kim SW, Ker CG, Committee TGR (2013) TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Surg 20:35–46
doi: 10.1007/s00534-012-0568-9
Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, Mayumi T, Yoshida M, Strasberg S, Pitt H, Gadacz TR, de Santibanes E, Gouma DJ, Solomkin JS, Belghiti J, Neuhaus H, Büchler MW, Fan ST, Ker CG, Padbury RT, Liau KH, Hilvano SC, Belli G, Windsor JA, Dervenis C (2007) Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 14:78–82
doi: 10.1007/s00534-006-1159-4
Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49:239–243
doi: 10.1097/00000542-197810000-00003
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
doi: 10.1097/01.sla.0000133083.54934.ae
Levy JH (2014) Role of coagulation factor concentrates for reversing dabigatran-related anticoagulation. Anesthesiology 120:1316–1318
doi: 10.1097/ALN.0000000000000254
Thachil J, Gatt A, Martlew V (2008) Management of surgical patients receiving anticoagulation and antiplatelet agents. Br J Surg 95:1437–1448
doi: 10.1002/bjs.6381
Kałuza GL, Joseph J, Lee JR, Raizner ME, Raizner AE (2000) Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol 35:1288–1294
doi: 10.1016/S0735-1097(00)00521-0
Wilson SH, Fasseas P, Orford JL, Lennon RJ, Horlocker T, Charnoff NE, Melby S, Berger PB (2003) Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting. J Am Coll Cardiol 42:234–240
doi: 10.1016/S0735-1097(03)00622-3
Chávez KV, Márquez-González H, Aguirre I, Orellana JC (2018) Prognostic risk factors for conversion in laparoscopic cholecystectomy. Updates Surg 70:67–72
doi: 10.1007/s13304-017-0494-0
Ho HS, Mathiesen KA, Wolfe BM (1996) The impact of laparoscopic cholecystectomy on the treatment of symptomatic cholelithiasis. Surg Endosc 10:746–750
doi: 10.1007/BF00193049
Brodsky A, Matter I, Sabo E, Cohen A, Abrahamson J, Eldar S (2000) Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted? A prospective study. Surg Endosc 14:755–760
doi: 10.1007/s004640000182
Hadad SM, Vaidya JS, Baker L, Koh HC, Heron TP, Hussain K, Thompson AM (2007) Delay from symptom onset increases the conversion rate in laparoscopic cholecystectomy for acute cholecystitis. World J Surg 31:1298–1303
doi: 10.1007/s00268-007-9050-2
Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gomi H, Yoshida M, Mayumi T, Miura F, Gouma DJ, Garden OJ, Büchler MW, Kiriyama S, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Gabata T, Higuchi R, Okamoto K, Hata J, Murata A, Kusachi S, Windsor JA, Supe AN, Lee S, Chen XP, Yamashita Y, Hirata K, Inui K, Sumiyama Y, Committee TGR (2013) TG13: Updated Tokyo guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 20:1–7
doi: 10.1007/s00534-012-0566-y
Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Gomi H, Dervenis C, Windsor JA, Kim SW, de Santibanes E, Padbury R, Chen XP, Chan AC, Fan ST, Jagannath P, Mayumi T, Yoshida M, Miura F, Tsuyuguchi T, Itoi T, Supe AN, Committee TGR (2013) TG13 surgical management of acute cholecystitis. J Hepatobiliary Pancreat Sci 20:89–96
doi: 10.1007/s00534-012-0567-x
Vaccari S, Lauro A, Cervellera M, Casella G, D’Andrea V, Di Matteo FM, Santoro A, Panarese A, Gulotta E, Cirocchi R, Ussia A, Brighi M, Romano A, Tonini V (2018) Early versus delayed approach in cholecystectomy after admission to an emergency department. A multicenter retrospective study. G Chir 39:232–238
pubmed: 30039791
Kwon AH, Matsui Y (2006) Laparoscopic cholecystectomy in patients aged 80 years and over. World J Surg 30:1204–1210
doi: 10.1007/s00268-005-0413-2
Kuy S, Sosa JA, Roman SA, Desai R, Rosenthal RA (2011) Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans. Am J Surg 201:789–796
doi: 10.1016/j.amjsurg.2010.04.018
Tucker JJ, Yanagawa F, Grim R, Bell T, Ahuja V (2011) Laparoscopic cholecystectomy is safe but underused in the elderly. Am Surg 77:1014–1020
doi: 10.1177/000313481107700820
Hazzan D, Geron N, Golijanin D, Reissman P, Shiloni E (2003) Laparoscopic cholecystectomy in octogenarians. Surg Endosc 17:773–776
doi: 10.1007/s00464-002-8529-z
Tambyraja AL, Kumar S, Nixon SJ (2005) POSSUM scoring for laparoscopic cholecystectomy in the elderly. ANZ J Surg 75:550–552
doi: 10.1111/j.1445-2197.2005.03428.x
Uecker J, Adams M, Skipper K, Dunn E (2001) Cholecystitis in the octogenarian: is laparoscopic cholecystectomy the best approach? Am Surg 67:637–640
pubmed: 11450778
Yasuda H, Matsuo Y, Sato Y, Ozawa S-I, Ishigooka S, Yamashita M, Yamamoto H, Itoh F (2015) Treatment and prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy. World J Crit 4:40–46
doi: 10.5492/wjccm.v4.i1.40