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

Abstract

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.

Preoperative Diagnosis of Neoplastic or Malignant Hürthle Cell Lesions: A Chimera?

“…Generally, FNAC is considered to be more useful for differentiating between neoplastic and nonneoplastic lesions than for detecting malignancy [23]. However, some authors have not found any association between cytological features and histological diagnosis [14].…”

Does the continuation of low-dose acetylsalicylic acid during the perioperative period of thyroidectomy increase the risk of cervical haematoma? A 1-year experience of two Italian centers

“…Cervical haematoma is an uncommon complication after thyroid surgery, occurring in 0.3-4.2% of cases [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]. It mostly occurs in the rst 6 hours after the surgical procedure, while after 24 hours it is quite infrequent [31,33,34,36,41,42,[44][45][46].…”

“…Ultimately, there are only two studies that evaluate the impact of the continuation of antiplatelet medications during the perioperative period of thyroid surgery [46,47].…”

“…The other two studies evaluating the effects of the continuation of antiplatelet agents during the perioperative period of thyroid surgery were conducted by Campbell et al and Raggio et al [46,47].…”

“…Raggio et al [47], based on the results of their analysis, stated that ASA can be continued in the perioperative period of thyroid surgery without increasing intraoperative bleeding. As regards the occurrence of cervical haematoma and RLN injury, these authors consider their ndings inconclusive due to the small sample size and number of outcome events.…”