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首页> 外文期刊>Surgical Endoscopy >Impact of perioperative aspirin continuation on bleeding complications in laparoscopic colorectal cancer surgery: a propensity score-matched analysis
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Impact of perioperative aspirin continuation on bleeding complications in laparoscopic colorectal cancer surgery: a propensity score-matched analysis

机译：围手术期阿司匹林继续对腹腔镜结直肠癌手术中出血并发症的影响：倾向分数匹配分析

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Background In laparoscopic surgery for colorectal cancer (CRC) for patients who receive antiplatelet therapy (APT), it remains unclear whether APT should be continued or temporarily withdrawn. We investigated the safety of perioperative aspirin continuation, specifically focused on bleeding complications. Methods We performed retrospective analysis utilizing propensity score-matching (PSM). In total, 789 patients satisfied the inclusion criteria, and were divided into two groups. Patients in the continued aspirin monotherapy (cAPT) group continued treatment perioperatively with not more than 2 days of withdrawal (n = 140). Patients with more than 3 days withdrawal of aspirin or who did not receive APT at all were assigned to the non-cAPT group (n = 649). After 1:1 PSM, 105 patients were extracted from each group. Perioperative APT management was determined based on our institutional committee-approved guidelines for antithrombotic management. Results In PSM cohorts, all patient demographics were comparable between the groups. Regarding intraoperative outcomes, we found no significant difference in operation duration (p = 0.969), blood loss (p = 0.068), and blood transfusion (p = 0.517). Postoperative overall morbidity was 20.0% and 13.3% in the cAPT and non-cAPT groups, respectively (p = 0.195). The incidence of bleeding complications was also comparable between the groups (2.9% vs. 1.0%, p = 0.317). Assessing the 14 cases with bleeding complications overall in the full cohort, all 7 cases in the non-cAPT group had anastomotic bleeding, which was generally observed shortly after surgery [median postoperative day (POD) 1]. All 7 cases in the cAPT group received additional antithrombotics other than aspirin; bleeding occurred at various sites relatively later (median POD 7), mostly after reinstitution of additional antithrombotic agents. Conclusions For patients receiving APT, perioperative continuation of aspirin monotherapy could be safe in laparoscopic CRC surgery; however, careful consideration is required at reinstitution of additional antithrombotics where multiple antithrombotic agents are used.
机译：背景在接受抗血小板治疗（APT）的结直肠癌腹腔镜手术（CRC）患者中，目前尚不清楚APT是否应该继续或暂时退出。我们调查了围手术期持续服用阿司匹林的安全性，特别关注出血并发症。方法采用倾向评分匹配（PSM）进行回顾性分析。总共有789名患者符合纳入标准，并被分为两组。持续阿司匹林单药治疗（cAPT）组的患者在围手术期继续接受治疗，停药时间不超过2天（n=140）。停用阿司匹林超过3天或根本没有服用APT的患者被分配到非cAPT组（n=649）。在1:1 PSM后，从每组抽取105名患者。围手术期APT管理是根据我们的机构委员会批准的抗血栓管理指南确定的。结果在PSM队列中，两组患者的所有人口统计数据具有可比性。关于术中结果，我们发现手术持续时间（p=0.969）、失血量（p=0.068）和输血量（p=0.517）没有显著差异。cAPT组和非cAPT组术后总发病率分别为20.0%和13.3%（p=0.195）。两组之间出血并发症的发生率也具有可比性（2.9%对1.0%，p=0.317）。评估整个队列中14例出现出血并发症的患者，非cAPT组的所有7例患者均出现吻合口出血，通常在术后不久观察到[术后中位天数（POD）1]。cAPT组的7例患者均接受了阿司匹林以外的其他抗血栓药物治疗；出血发生在各个部位的时间相对较晚（中位POD 7），主要是在重新服用其他抗血栓药物后。结论对于接受APT治疗的患者，在腹腔镜结直肠癌手术中，围手术期继续阿司匹林单药治疗是安全的；然而，在使用多种抗血栓药物的情况下，重新使用额外的抗血栓药物时需要仔细考虑。

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