Antiplatelet and anticoagulation therapy in microlaryngeal surgery

Francis, David O.; Dang, Jennifer; Fritz, Mark; Garrett, C. Gaelyn

doi:10.1002/lary.24359

Cited by 17 publications

(23 citation statements)

References 30 publications

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“…Francis et al performed a retrospective review regarding the safety of antiplatelet therapy in patients undergoing operative microlaryngeal surgery under general anesthesia and showed that there was no difference in the incidence of bleeding complications based on antiplatelet status. 22 Another study by Fritz et al showed that continuing these treatments during in-office laryngeal procedures did not increase the risk of complications. 23 The decision to hold antithrombotic therapy is dependent on the risk of perioperative bleeding if the antithrombotic therapy were to be continued, versus the thromboembolic risk if the therapy were interrupted or discontinued.…”

Section: Discussionmentioning

confidence: 99%

“…This is similar to results of previous studies regarding laryngeal surgery. Francis et al performed a retrospective review regarding the safety of antiplatelet therapy in patients undergoing operative microlaryngeal surgery under general anesthesia and showed that there was no difference in the incidence of bleeding complications based on antiplatelet status . Another study by Fritz et al showed that continuing these treatments during in‐office laryngeal procedures did not increase the risk of complications …”

Section: Discussionmentioning

confidence: 99%

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Anticoagulation and antiplatelet therapy in awake transcervical injection laryngoplasty

2017

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anticoagulation and antiplatelet therapy in awake transcervical injection laryngoplasty

2017

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“…no increased risk of bleeding in patients on antithrombotics. 25 Subsequent studies by Fritz et al and Dang et al had similar findings in the office setting and at the bedside, respectively, but the smaller size of these studies prevented them from drawing formal conclusions. 7,26 The present study sought to validate the findings of those before which would require about 5000 patients per group.…”

Section: Introductionmentioning

confidence: 94%

The safety of in‐office laryngologic procedures during active antithrombotic therapy

Straub

Calamari

Shin

et al. 2020

Laryngoscope Investig Oto

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Objectives: To determine whether patients undergoing in-office laryngologic procedures on antithrombotic therapy are at increased risk for treatment-related complications. Methods: Patients were those who underwent at least one in-office laryngologic procedure with any of three fellowship-trained laryngologists. Procedures were identified by current procedural terminology (CPT) code and included biopsies, excisions, laser ablations, and injections (therapeutic and augmentative). Patients were divided into two groups based on the use of antithrombotic therapy at the time of their procedure. Retrospective chart review was performed to identify any complications, with an average follow-up of 186 days. Results: Five hundred-sixty-four unique individuals were identified with ages ranging from 18 to 93 years old and with a relatively even distribution between females (45%) and males (55%). They underwent 647 procedures in total, 310 of which were performed while on some form of antithrombotic therapy. Sixteen procedures were associated with complications either during or after the procedure. In comparing overall complication rates, there was no significant difference between nonantithrombotic (2.4%) and antithrombotic (3.3%) cohorts (OR 1.09, 95% CI [0.46-2.60], P = .8454). Conclusions: In spite of known risks in other settings, antithrombotic agents do not appear to confer increased risk of treatment-related complications during in-office laryngologic procedures, obviating the need for cessation of therapy prior to these interventions.

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“…Several studies support the safe continuation of aspirin therapy during various otolaryngologic and other surgical procedures anatomically related to the head and neck, including cataract surgery, 29 vitreoretinal surgery, 30 dental osteotomy, 31 cutaneous surgery, 32,33 in-office laryngologic procedures, 34 and microlaryngeal surgery. 35 Nevertheless, scarce evidence and Abbreviations: BMI, body mass index (calculated as the weight in kilograms divided by height in meters squared); EBL, estimated blood loss; NA, not applicable; RLN, recurrent laryngeal nerve; SBL, substantial blood loss (EBL >10 mL); TSH, thyroid-stimulating hormone. a Effect size calculated using raw group differences, including comparison of means and comparison of proportions where appropriate.…”

Section: Safety Of Aspirin In Otolaryngologic Surgerymentioning

confidence: 99%

Association of Continued Preoperative Aspirin Use and Bleeding Complications in Patients Undergoing Thyroid Surgery

Raggio

Barton

Kandil

et al. 2018

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE No evidence exists to direct the management of preoperative aspirin (acetylsalicylic acid) use in patients undergoing thyroid surgery. Nevertheless, a considerable number of patients interrupt receiving aspirin therapy during the preoperative period to minimize bleeding complications despite the increased risk of experiencing major adverse cardiac events. OBJECTIVE To determine whether aspirin therapy continued preoperatively increases bleeding complications in patients undergoing thyroid surgery. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of a consecutive sample of 570 patients, aged 18 to 100 years, who underwent thyroid surgery for benign and malignant disease from January 1, 2010, to December 31, 2015, by a single surgeon at a tertiary referral hospital center in New Orleans, Louisiana. EXPOSURES Patients receiving aspirin therapy and patients not receiving aspirin therapy (aspirin naive) preoperatively. MAIN OUTCOMES AND MEASURES Comparison of estimated blood loss, substantial blood loss, operative hematoma, nonoperative hematoma, and recurrent laryngeal nerve injury. RESULTS Of 570 patients who underwent thyroid surgery, 106 (18.6%) were performed in patients receiving aspirin; of these, 23 (21.7%) were men and 105 (99.1%) were older than 45 years. Those receiving aspirin therapy displayed a 14.4-year difference in age (95% CI, 11.6-17.1). The aspirin group displayed a 20.3% absolute increase (95% CI, 9.3-30.7) in African American patients. Aspirin therapy was not associated with a statistically significant or clinically meaningful increase in intraoperative blood loss (2.5 mL; 95% CI,-0.4 to 5.3). Aspirin therapy was associated with a statistically significant increase in total hematoma formation (3.3%; 95% CI, 0.4-9.0), but the results were inconclusive. Aspirin therapy was not associated with a statistically significant increase in recurrent laryngeal nerve injury (2.6%; 95% CI,-1.1 to 8.6), but the results were inconclusive. CONCLUSIONS AND RELEVANCE These results suggest that aspirin therapy can be maintained prior to thyroid surgery without increased intraoperative bleeding. Further research with a larger sample size and more outcome events are required to make definitive conclusions regarding the association between aspirin use and complications, including hematoma and recurrent laryngeal nerve injury.

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Antiplatelet and anticoagulation therapy in microlaryngeal surgery

Abstract: 4.

Cited by 17 publications

References 30 publications

Anticoagulation and antiplatelet therapy in awake transcervical injection laryngoplasty

Anticoagulation and antiplatelet therapy in awake transcervical injection laryngoplasty

The safety of in‐office laryngologic procedures during active antithrombotic therapy

Association of Continued Preoperative Aspirin Use and Bleeding Complications in Patients Undergoing Thyroid Surgery

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