Is breast cancer surgery safely performed in patients receiving antithrombotic therapy?

Abstract

Aim: The aim of the study was to assess the safety of surgery for breast cancer in patients with antithrombotic therapy (ATT), including antiplatelet therapy (APT) and anticoagulation therapy (ACT) for thromboembolic risks. Methods: One hundred ninety-three consecutive patients receiving breast surgery for breast cancer at our institution between 2010 and 2015 were retrospectively reviewed. Among them, ATT was regularly used in 50 patients (25.9%). Our perioperative management included maintenance of preoperative aspirin monotherapy for APT and bridging heparin for ACT in patients at high thromboembolic risks and early postoperative reinstitution in all ATT cases. The outcome variables of patients with ATT (ATT group) were compared to those of patients without ATT (non-ATT group), and the significant risk factors for postoperative complications were determined by multivariate analysis. Results: This series included 127 mastectomy and 66 breast-conserving surgery. ATT group showed significantly high frequency of history of cerebral infarction and percutaneous coronary intervention (PCI). In the ATT group, 32 patients (16.6%) were categorized as high risk for thromboembolism, but there was neither thromboembolic event nor perioperative death in the whole cohort. Surgical blood loss and rates of intraoperative transfusion were identical between the groups. Whereas overall postoperative bleeding complication was more frequently observed in the ATT group compared to the non-ATT group (12.0% vs. 3.5%, p = 0.360) in univariate analyses, multivariate analysis showed that neither ATT nor preoperative aspirin continuation affected postoperative bleeding complications. Conclusion: Even in patients undergoing ATT, surgery for breast cancer is safely performed without any increase in blood loss or postoperative bleeding, and no thromboembolism was experienced in the series. Our perioperative management of ATT patients is valid during breast surgery, although this patient population is still challenging and should be rigorously managed.

Pre-, intra-, and/or postoperative arterial and venous thromboembolism prophylaxis for breast surgery: Systematic review and meta-analysis

“…The intraoperative group reported 26 UFH, 16 , 23 310 LMWH, 17 and 35 aspirin patients. 16 The postoperative group reported 792 UFH, 20 , 21 , 24 1085 LMWH, 17 -21 , 24 392 aspirin, 16 , 21 and 21 warfarin patients. 16 Postoperative durations ranged from time of surgery to hospital discharge to one month following surgery.…”

“…16-21 , 24 The most reported prophylactic groups were preoperative (8/11 studies), 14 -16 , 18 -20 , 22 , 24 followed by postoperative (7/11 studies), 16 -21 , 24 and intraoperative (3/11 studies). 16,17,23 There was one prospective randomized trial 17 and ten retrospective cohort studies. 14 -16 , 18 -24 Eight studies were performed in the United States, 14 , 15 , 18 , 20 -24 one in Korea, 19 one in Japan, 16 and one in Denmark.…”

“…16,17,23 There was one prospective randomized trial 17 and ten retrospective cohort studies. 14 -16 , 18 -24 Eight studies were performed in the United States, 14 , 15 , 18 , 20 -24 one in Korea, 19 one in Japan, 16 and one in Denmark. 17 Of 117 possible outcomes and complications queried, 92 had attainable results ( Tables 2 and 3 ).…”

“…24 Aspirin was reported in 2/11 studies, 16 , 21 and warfarin was reported in one study. 16 The preoperative group reported 774 UFH, 16 , 20 , 22 , 24 496 LMWH, 14 , 18 , 19 , 24 and 50 aspirin patients. 16 Preoperative durations ranged from continuing daily outpatient medication to starting one hour prior to surgery.…”

“…16 The preoperative group reported 774 UFH, 16 , 20 , 22 , 24 496 LMWH, 14 , 18 , 19 , 24 and 50 aspirin patients. 16 Preoperative durations ranged from continuing daily outpatient medication to starting one hour prior to surgery. The intraoperative group reported 26 UFH, 16 , 23 310 LMWH, 17 and 35 aspirin patients.…”