16 Aug Laparoscopic Surgery: Effect of Antiplatelet Therapy on Outcome
MedicalResearch.com Interview with:
Dr. Takahisa Fujikawa, MD, PhD, FACS.
Director, Dept of Surgery, Kokura Memorial Hospital,
3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, JAPAN.
MedicalResearch.com: What are the main findings of the study?
A total of consecutive 1,075 patients undergoing abdominal laparoscopic surgery between 2005 and 2011, including 715 basic and 360 advanced laparoscopic surgeries, were reviewed. The perioperative management protocol consists of interruption of antiplatelet therapy (APT) one week before surgery and early postoperative re-institution in low thromboembolic risk patients (n=160, iAPT group), whereas preoperative APT was maintained in patients with high thromboembolic risk or emergent situation (n=52, cAPT group). Perioperative and outcome variables of cAPT and iAPT groups, including bleeding and thromboembolic complications, were compared to those of patients without APT (non-APT group, n=863).
- No case suffering excessive intraoperative bleeding due to continuation of APT was observed. There were 10 postoperative bleeding complications (0.9%) and 3 thromboembolic events (0.3%), but surgery was free of both complications in cAPT group. No significant differences were found between the groups in operative blood loss, blood transfusion rate, and the occurrence of bleeding and thromboembolic complications.
- Multivariable analyses showed that multiple antiplatelet agents (p=0.015) and intraoperative blood transfusion (p=0.046) were significant prognostic factors for postoperative bleeding complications. Increased thromboembolic complications were independently associated with high New York Heart Association class (p=0.019) and history of cerebral infarction (p=0.048), but not associated with APT use.
MedicalResearch.com: Were any of the findings unexpected?
Answer: No. Using rigorous perioperative assessment and management, satisfactory outcome was obtained without any increase of severe complications, such as bleeding or thromboembolic complications, in patients with APT.
Answer: What should clinicians and patients take away from your report?
- Under rigorous perioperative assessment and management, abdominal laparoscopic surgeries, whether basic or advanced procedures, were successfully performed without severe complications even in patients with antiplatelet therapy (APT).
- Maintenance of single APT should be considered in patients with high thromboembolic risk, even when an abdominal laparoscopic approach was considered.
Answer: What recommendations do you have for future research as a result of this study?
- We are trying to expand the research to the patient population including more high risk surgery such as open major HBP surgery or esophagectomy.
- We will also have an attempt to expand this research to gastroenterological cancer patient population and to assess the effect of APT on short-term and long-term outcome of cancer patients.
Does antiplatelet therapy affect outcome of patients receiving abdominal laparoscopic surgery? Lessons from over 1,000 laparoscopic surgeries in a single tertiary referral hospital
Takahisa Fujikawa, Akira Tanaka, Toshihiro Abe, Yasunori Yoshimoto, Seiichiro Tada, Hisatsugu Maekawa, Norihiro Shimoike
Journal of the American College of Surgeons – 13 August 2013 (10.1016/j.jamcollsurg.2013.08.005)