Use of aspirin and bleeding-related complications after hepatic resection

Gelli, Maximiliano; Allard, Marc‐Antoine; Farges, Olivier; Paugam–Burtz, Catherine; Mabrut, Jean‐Yves; Régimbeau, Jean Marc; Vibert, Éric; Boleslawski, Emmanuel

doi:10.1002/bjs.10697

Cited by 9 publications

(2 citation statements)

References 58 publications

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“…Peri-operative continuation of aspirin was not significantly associated with a higher risk of severe haemorrhagic complications in patients undergoing elective hepatectomy 599,600 …”

Section: Discussionmentioning

confidence: 98%

“…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%

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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

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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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“…Peri-operative continuation of aspirin was not significantly associated with a higher risk of severe haemorrhagic complications in patients undergoing elective hepatectomy 599,600 …”

Section: Discussionmentioning

confidence: 98%

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

View full text Add to dashboard Cite

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

Naito

Fujikawa

Hasegawa

2020

J Hepato Biliary Pancreat

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Background: There is insufficient evidence concerning the effect of preoperative continuation of antiplatelet therapy (APT) on intraoperative and postoperative bleeding during liver resection. This study investigated the efficacy and safety of preoperative aspirin continuation on bleeding complications during or after liver resection using propensity score matching (PSM). Methods: Between 2005 and 2018, 425 patients who underwent liver resection were enrolled in this study. Patients were divided into two groups; the cAPT group received continued aspirin monotherapy preoperatively (n = 63) and the control group did not (n = 362). Propensity score matching was performed based on the preoperative clinical parameters. Intraoperative and postoperative complications, including bleeding complications, were compared between groups. Results: After propensity score matching, 126 patients were included in the analysis (cAPT group, n = 63 and control group, n = 63). There were no differences in patients' background characteristics, and intraoperative blood loss was identical between the groups (200 vs 180 mL, P = .54). The frequency of postoperative complications (Clavien-Dindo class 2 or higher, 13/63 [20.6%] vs 13/63 [20.6%], P = 1.00) and postoperative hemorrhagic complication (3/63 [4.8%] vs 3/63 [4.8%], P = 1.00) was also similar between the groups; no difference was observed in the length of postoperative stay (11 days vs 14 days, P = .08). Conclusion: Preoperative continuation of aspirin monotherapy does not affect intraoperative or postoperative bleeding in patients receiving liver resection. Either open or laparoscopic liver resection can be safely performed in patients with continued aspirin therapy.

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The Impact of Nonsteroidal Anti-inflammatory Drugs on Older Adult Trauma Patients With Hip Fractures

Haines

Fuller

Vaughan

et al. 2020

Journal of Surgical Research

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Use of aspirin and bleeding-related complications after hepatic resection

Abstract: This observational study suggested that aspirin continuation is not associated with a higher rate of bleeding-related complications after elective hepatic surgery.

Cited by 9 publications

References 58 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

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

The Impact of Nonsteroidal Anti-inflammatory Drugs on Older Adult Trauma Patients With Hip Fractures

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