Impact of preoperative aspirin continuation on bleeding complications during or after liver resection: Propensity score‐matched analysis

Naito, Shigetoshi; Fujikawa, Takahisa; Hasegawa, Suguru

doi:10.1002/jhbp.735

Cited by 6 publications

(9 citation statements)

References 37 publications

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“…598 Peri-operative continuation of aspirin was not significantly associated with a higher risk of severe haemorrhagic complications in patients undergoing elective hepatectomy. 599,600 Orthotopic liver transplantation Several studies have demonstrated the association between intra-operative bleeding and blood product transfusion with postoperative morbidity and mortality after OLT. [601][602][603] Intra-operative bleeding is associated with an increased likelihood of tumour recurrence following OLT for HCC, with a more pronounced effect in patients exceeding the Milan criteria.…”

Section: Liver Surgerymentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

111

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Section: Liver Surgerymentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

111

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“…All procedures were performed by, or under the guidance of one of the board‐certified surgeons of the participating institution. The “two‐surgeon technique” for open hepatectomy reportedly enables safe parenchymal resection of the liver without severe intraoperative bleeding; 20 we applied this approach to LLR 21,22 . With this technique, rapid hemostasis is possible by clearly dividing the roles (eg, liver resection would be managed by the main surgeon and hemostasis by the assistant surgeon).…”

Section: Methodsmentioning

confidence: 99%

“…The "two-surgeon technique" for open hepatectomy reportedly enables safe parenchymal resection of the liver without severe intraoperative bleeding; 20 we applied this approach to LLR. 21,22 With this technique, rapid hemostasis is possible by clearly dividing the roles (eg, liver resection would be managed by the main surgeon and hemostasis by the assistant surgeon). The indication for LLR was limited to a tumor diameter of ≤10 cm.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Is laparoscopic liver resection safe for super‐elderly patients (aged ≥80)? A propensity score‐matched analysis

Naito

Fujikawa

Kouno

et al. 2021

Asian J Endoscop Surgery

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Background/Purpose The safety of laparoscopic liver resection in super‐elderly patients with comorbidities is unknown. We used propensity score matching to evaluate the utility and safety of laparoscopic liver resection in super‐elderly patients. Methods Two‐hundred and five patients who underwent laparoscopic liver resection were retrospectively reviewed. They were classified into two groups based on age: ≥80 years (elderly group, n = 49) and <80 years (control group, n = 156). Propensity score matching (PSM) was performed based on preoperative clinical parameters. The intraoperative and postoperative outcomes were compared. Results After matching, 45 patients were included in each group. The intraoperative blood loss was identical between the control and elderly groups (60 vs 60 mL, respectively, P = .588); the frequency of serious postoperative complications (Clavien–Dindo class ≥3, 1/45 vs 1/45, P = 1.00) was also similar. There was no significant difference in terms of the exacerbation of malignancy (22.2% vs 11.1%, P = .258) or other diseases (8.9% vs 22.2%, P = .144). There was no difference in overall survival before and after PSM. However, 5‐year overall survival excluding primary cancer‐related death showed a difference after PSM (90.7% vs 70.4%; P = .048). Conclusions Laparoscopic liver resection is feasible and safe in super‐elderly patients. The long‐term prognosis was poor in patients affected by other illnesses compared to the younger population with similar risk profiles, but there was no difference in overall survival.

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“…Two retrospective cohort studies employing a large number of cases were reported on laparoscopic GE surgery [ 6 ] and open GE surgery [ 7 ] to provide evidence for the safety of preoperative aspirin treatment during GE operations. Preoperative aspirin monotherapy did not affect the occurrence of surgical blood loss or postoperative bleeding complications in various types of GE surgery, including pancreatic surgery [ 10 ], liver resection [ 11 , 12 ], laparoscopic cholecystectomy [ 13 ], and laparoscopic colorectal surgery [ 14 ], according to recently published studies. Furthermore, Fujikawa et al found that stopping APT before surgery was the most important risk factor for perioperative thromboembolic events and that continuing aspirin before surgery lowered the risk of thromboembolism considerably [ 2 ].…”

Section: Reviewmentioning

confidence: 99%

“…Although using a single aspirin in the perioperative phase is not linked to an increased risk of major bleeding issues [ 12 , 14 ], using several APTs or a combination of ACT and APT in surgical patients is more difficult. In a meta-analysis of large studies, dual APT with clopidogrel and aspirin was connected to a higher risk of severe bleeding [ 16 ].…”

Section: Reviewmentioning

confidence: 99%

Perioperative Antithrombotic Management During Gastroenterological Surgery in Patients With Thromboembolic Risks: Current Status and Future Prospects

Fujikawa¹

2022

Cureus

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Antiplatelet medicines and anticoagulants are two types of antithrombotic pharmaceuticals, with anticoagulants including warfarin and direct oral anticoagulants (DOACs). During the perioperative phase, patients receiving antithrombotic therapy must balance two risks: bleeding and thromboembolism. To date, there are no defined recommendations for antithrombotic drug management in gastroenterological (GE) surgery, and the management strategy varies greatly between hospitals. The perioperative treatment of antithrombotic medications should be centralized according to the mechanism of each drug, and a suitable management strategy should be established. The proposed perioperative management for patients undergoing antithrombotic therapy is as follows: (1) in the case of antiplatelet medication, aspirin monotherapy is continued; (2) for patients on warfarin, it is substituted by DOAC bridging (preferred) or heparin bridging; and (3) in the case of DOACs, the short-term withdrawal of DOACs (typically 1-2 days) without heparin bridging is indicated. In the current review, the current state and future prospects of perioperative antithrombotic medication treatment during gastroenterological surgery are discussed.

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Impact of preoperative aspirin continuation on bleeding complications during or after liver resection: Propensity score‐matched analysis

Cited by 6 publications

References 37 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Is laparoscopic liver resection safe for super‐elderly patients (aged ≥80)? A propensity score‐matched analysis

Perioperative Antithrombotic Management During Gastroenterological Surgery in Patients With Thromboembolic Risks: Current Status and Future Prospects

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