The efficacy of laparoscopic cholecystectomy without discontinuation in patients on antithrombotic therapy

Abstract

PurposeLaparoscopic cholecystectomy (LC) is one of the most commonly performed surgeries in the world today. However, there is no consensus regarding whether LC can be performed in patients with acute cholecystitis while on antithrombotic therapy. The objective of our study was to describe postoperative outcomes of patients who underwent emergent LC without interruption to antithrombotic therapy.MethodsWe performed a retrospective review of patients who underwent LC for acute cholecystitis while on antithrombotic therapy from 2010 to 2015 at Soonchunhyang Universtiy Cheonan Hospital. Patients were divided into 2 groups as underwent emergent LC and elective LC.ResultsA total of 67 patients (emergent group, 22; elective group, 45) were included in the analysis. Elective group had significantly longer duration between the admission and operation (8 [7–10] days vs. 2 [1–3] days, P < 0.001) and longer duration of antithrombotic drugs discontinuation (7 days vs. 1 [0–3] days, P < 0.001). Emergent group had significantly more postoperative anemia (6 patients vs. 0 patient, P = 0.001) and 3 of 6 patients received packed RBC transfusion in postoperative period. However, there was no significant difference in length of postoperative stays, length of intensive care unit stays and mortality rates.ConclusionEmergent LC without interruption to antithrombotic therapy was relatively safe and useful. A well-designed multicenter study is needed to confirm the safety and efficacy of LC without suspension of antithrombotic therapy and to provide a simple guideline.

Safety of laparoscopic surgery in digestive diseases with special reference to antithrombotic therapy: A systematic review of the literature

“…In basic laparoscopic surgeries, only two types of surgery (cholecystectomy and appendectomy) were included. Laparoscopic cholecystectomy was the most commonly reported overall, and a total of eight studies were included[ 11 - 15 , 17 , 18 , 24 ]. Research on laparoscopic appendectomy included two case-control studies[ 19 , 20 ].…”

Current Status in the Treatment of Acute Cholecystitis Patients Receiving Antithrombotic Therapy: Is Endoscopic Drainage Feasible?- A Systematic Review

“…Research article collection and screening were conducted from January 2019 to February 2019. A total of 8 studies on surgical cholecystectomy (mainly LC), [11][12][13][14][15][16][17][18] 3 studies on PTGBD, [19][20][21] and 1 study on EGBD 5 in patients receiving ATT were selected for data extraction and satisfied our inclusion criteria. As only 1 study on EGBD in patients receiving ATT was retrieved through the search method mentioned above, articles were additionally searched using the keywords "ETGBD" and "EUS-GBD".…”

“…In the 12 studies that evaluated surgery and gallbladder drainage, patients receiving ATT, including aspirin and/or thienopyridine, were the focus of 3 studies. 12,14,15 Only 1 study evaluated patients receiving anticoagulant therapy with heparin bridging, 11 1 study evaluated patients receiving anticoagulant therapy and/or with coagulopathy, 19 and the other studies 5,13,[16][17][18]20,21 evaluated patients receiving antiplatelet agents and/or anticoagulants during surgery (LC or OC) or internal drainage (PTGBD or EGBD) without discontinuation of ATT (Table 1).…”

“…12,14,15 In some cases of cholecystectomy in patients receiving antiplatelet agents and/or anticoagulants, there were similar tendencies found in LC. 13,16 On the other hand, 2 studies on cholecystectomy in patients receiving antiplatelet agents and/or anticoagulants reported that anemia was more frequently observed in patients who underwent emergency LC with continuation of ATT, 17 and that treatment with multiple antiplatelet therapies and anticoagulation therapies was an independent predictor for postoperative bleeding complications. 18 Moreover, in a study on LC, it was proven that patients receiving heparin bridging therapy had a significantly higher rate of surgical blood loss than those without anticoagulants.…”

“…[11][12][13][14][15][16][17][18] Several studies reported that LC in patients receiving ATT might not increase bleeding-related events. [12][13][14][15][16][17] On the contrary, other studies reported that emergency LC has a significant risk of bleeding complications in patients receiving mono-or multiple ATT, 17,18 and in those receiving heparin bridging therapy. 11 In our review, 6.5% of the patients receiving ATT who underwent LC (OC in part) experienced bleeding complications, and the rate was significantly higher than that in patients without ATT.…”