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

Abstract

Background: A growing number of patients taking antiplatelet drugs, mainly low-dose acetylsalicylic acid (ASA) (75–150 mg/day), for primary or secondary prevention of thrombotic events, are encountered in every field of surgery. While the bleeding risk due to the continuation of these medications during the perioperative period has been adequately investigated in several surgical specialties, in thyroid surgery it still needs to be clarified.The main aim of this study was to assess the occurrence of cervical haematoma in patients receiving low-dose acetylsalicylic acid, specifically ASA 100 mg/day, during the perioperative period of thyroidectomy.Methods: Patients undergoing thyroidectomy in two high-volume thyroid surgery centers in Italy, between January 2021 and December 2021, were retrospectively analysed. Enrolled patients were divided into two groups: those not taking ASA were included in Group A, while those receiving this drug in Group B.Results: A total of 412 patients underwent thyroidectomy during the study period. Among them, 29 (7.04%) were taking ASA: 15 (51.72%) for primary prevention and 14 (48.28%) for secondary prevention. Based on the inclusion criteria, 351 patients were enrolled: 322 were included in Group A and 29 in Group B. In Group A, there were 4 (1.24%) cervical haematomas not requiring surgical revision of haemostasis, 4 (1.24%) cervical haematomas requiring surgical revision of haemostasis, 50 (15.53%) cases of postoperative hypoparathyroidism, 14 (4.35%) unilateral RLN lesions and 4 (1.24%) wound infections. In Group B, there were 1 (3.45%) cervical haematoma requiring surgical revision of haemostasis, 3 (10.34%) cases of postoperative hypoparathyroidism and 2 (6.90%) unilateral RLN lesions. No statistically significant difference was found in terms of complications between the two groups.Conclusions: Continuation of ASA 100 mg/day during the perioperative period of thyroidectomy did not increase the occurrence of cervical haematoma and the other early complications of thyroid surgery. Based on our findings, we believe that in patients receiving this drug, either for primary or secondary prevention of thrombotic events, its discontinuation during the perioperative period of thyroidectomy is not necessary.