2019 Volume 112 Issue 11 Pages 769-774
Introduction: Recently, the number of patients receiving anti-thrombotic therapies has been increasing. Anti-thrombotic therapy increases the risk of bleeding during surgical procedures, while interruption of the therapy would increase the risk of intraoperative thromboembolism. This is the reason why decision-making on surgical procedures in patients receiving anti-thrombotic therapy is sometimes quite troublesome. Here, we retrospectively investigated the impact of anti-thrombotic therapy in patients undergoing surgery at our institution during the several years.
Method: The retrospective study was performed in 3893 patients who underwent surgeries, except ear surgeries at our department, between 2013 to 2018. The distributions of the age, gender, type of surgery, amount of intraoperative bleeding, and incidence of postoperative bleeding were compared between the patients in whom the anti-thrombotic therapy was interrupted and those in whom it was continued.
Results: About 13% of patients were receiving anti-thrombotic therapy prior to the scheduled operation. There were higher numbers of patients on anti-thrombotic therapy among male and elderly subjects and among patients with malignancy. Of these patients, the anti-thrombotic therapy was continued in 40% and interrupted in 60% of patients. The duration of surgery and volume of bleeding were lower in the patients in whom the anti-thrombotic therapy was continued, presumably because these patients mainly underwent minor surgeries or surgeries under local anesthesia. Among the cases that underwent major surgeries under general anesthesia, there was no statistically significant difference in the incidence of postoperative bleeding between the patients in whom the anti-thrombotic therapy was continued and those in whom it was interrupted.
Conclusion: We concluded that surgical procedures can be performed safely even in patients in whom anti-thrombotic therapy is continued, if we limit the scale of the operation and modify the intensity of the anti-thrombotic therapy. However, it is noteworthy that we encountered several cases with delayed onset of postoperative bleeding among the cases in whom the anti-thrombotic therapy was continued.
