Skip to main content
Erschienen in: Surgery Today 6/2021

03.01.2021 | Original Article

Continuation of aspirin perioperatively for lung resection: a propensity matched analysis

verfasst von: Takashi Sakai, Keiju Aokage, Shinya Katsumata, Kenta Tane, Tomohiro Miyoshi, Masahiro Tsuboi

Erschienen in: Surgery Today | Ausgabe 6/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To clarify the safety and effectiveness of continuing aspirin during the perioperative period of lung resection.

Methods

We analyzed, retrospectively, consecutive patients who underwent lung resection between 2008 and 2017. To investigate the safety of aspirin continuation, patients who continued taking aspirin perioperatively (Group C) were matched to other patients (Group O), using a propensity score, and bleeding outcomes were compared. To assess the effect of aspirin interruption, Group C was matched to a group of patients whose aspirin regimen was interrupted (Group I), and the postoperative complications related to thromboembolism were compared.

Results

Among 3393 patients, 52 continued on aspirin (Group C) perioperatively, whereas 184 had their aspirin discontinued (Group I). Comparing the matched cohorts extracted from Group C and Group O (n = 45), there were no significant differences in bleeding outcomes. Comparing the matched cohorts extracted from Group C and Group I (n = 40), group C had fewer postoperative complications related to thromboembolism (0% vs. 7.5%, p = 0.039).

Conclusion

Bleeding complications did not increase by continuing aspirin, but thromboembolic complications increased when the aspirin regimen was interrupted during the perioperative period of lung resection. Thus, in the absence of a prohibitive bleeding risk, the continuation of aspirin during the perioperative period of lung resection appears to be desirable.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Brunelli A, Varela G, Salati M, Jimenez MF, Pompili C, Novoa N, et al. Recalibration of the revised cardiac risk index in lung resection candidates. Ann Thorac Surg. 2010;90:199–203.CrossRef Brunelli A, Varela G, Salati M, Jimenez MF, Pompili C, Novoa N, et al. Recalibration of the revised cardiac risk index in lung resection candidates. Ann Thorac Surg. 2010;90:199–203.CrossRef
2.
Zurück zum Zitat Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:2215–45.CrossRef Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:2215–45.CrossRef
3.
Zurück zum Zitat Kristensen SD, Knuuti J, Saraste A, Anker S, Botker HE, De Hert S, et al. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35:2383–431.CrossRef Kristensen SD, Knuuti J, Saraste A, Anker S, Botker HE, De Hert S, et al. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35:2383–431.CrossRef
4.
Zurück zum Zitat Biondi-Zoccai GGL, Lotrionte M, Agostoni P, Abbate A, Fusaro M, Burzotta F, et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J. 2006;27:2667–74.CrossRef Biondi-Zoccai GGL, Lotrionte M, Agostoni P, Abbate A, Fusaro M, Burzotta F, et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J. 2006;27:2667–74.CrossRef
5.
Zurück zum Zitat Maulaz AB, Bezerra DC, Michel P, Bogousslavsky J. Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Arch Neurol. 2005;62:1217–20.CrossRef Maulaz AB, Bezerra DC, Michel P, Bogousslavsky J. Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Arch Neurol. 2005;62:1217–20.CrossRef
6.
Zurück zum Zitat Devereaux PJ, Mrkobrada M, Sessler DI, Leslie K, Alonso-Coello P, Kurz A, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370:1494–503.CrossRef Devereaux PJ, Mrkobrada M, Sessler DI, Leslie K, Alonso-Coello P, Kurz A, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370:1494–503.CrossRef
7.
Zurück zum Zitat Darvish-Kazem S, Gandhi M, Marcucci M, Douketis JD. Perioperative management of antiplatelet therapy in patients with a coronary stent who need noncardiac surgery: a systematic review of clinical practice guidelines. Chest. 2013;144:1848–56.CrossRef Darvish-Kazem S, Gandhi M, Marcucci M, Douketis JD. Perioperative management of antiplatelet therapy in patients with a coronary stent who need noncardiac surgery: a systematic review of clinical practice guidelines. Chest. 2013;144:1848–56.CrossRef
8.
Zurück zum Zitat Columbo JA, Lambour AJ, Sundling RA, Chauhan NB, Bessen SY, Linshaw DL, et al. A meta-analysis of the impact of aspirin, clopidogrel, and dual antiplatelet therapy on bleeding complications in noncardiac surgery. Ann Surg. 2018;267:1–10.CrossRef Columbo JA, Lambour AJ, Sundling RA, Chauhan NB, Bessen SY, Linshaw DL, et al. A meta-analysis of the impact of aspirin, clopidogrel, and dual antiplatelet therapy on bleeding complications in noncardiac surgery. Ann Surg. 2018;267:1–10.CrossRef
9.
Zurück zum Zitat Taguchi K, Shimomura M, Egi H, Hattori M, Mukai S, Kochi M, et al. Is laparoscopic colorectal surgery with continuation of antiplatelet therapy safe without increasing bleeding complications? Surg Today. 2019;49:948–57.CrossRef Taguchi K, Shimomura M, Egi H, Hattori M, Mukai S, Kochi M, et al. Is laparoscopic colorectal surgery with continuation of antiplatelet therapy safe without increasing bleeding complications? Surg Today. 2019;49:948–57.CrossRef
10.
Zurück zum Zitat Cerfolio RJ, Minnich DJ, Bryant AS. General thoracic surgery is safe in patients taking clopidogrel (Plavix). J Thorac Cardiovasc Surg. 2010;140:970–6.CrossRef Cerfolio RJ, Minnich DJ, Bryant AS. General thoracic surgery is safe in patients taking clopidogrel (Plavix). J Thorac Cardiovasc Surg. 2010;140:970–6.CrossRef
11.
Zurück zum Zitat Kanzaki R, Inoue M, Minami M, Shintani Y, Nakagiri T, Funaki S, et al. Feasibility of aspirin continuation during the perioperative period for pulmonary resection in lung cancer patients: a retrospective study at a single institute in Japan. Surg Today. 2014;44:2243–8.CrossRef Kanzaki R, Inoue M, Minami M, Shintani Y, Nakagiri T, Funaki S, et al. Feasibility of aspirin continuation during the perioperative period for pulmonary resection in lung cancer patients: a retrospective study at a single institute in Japan. Surg Today. 2014;44:2243–8.CrossRef
12.
Zurück zum Zitat Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.CrossRef Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.CrossRef
14.
Zurück zum Zitat Ferraris VA, Saha SP, Oestreich JH, Song HK, Rosengart T, Reece TB, et al. 2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drugs in patients having cardiac and noncardiac operations. Ann Thorac Surg. 2012;94:1761–81.CrossRef Ferraris VA, Saha SP, Oestreich JH, Song HK, Rosengart T, Reece TB, et al. 2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drugs in patients having cardiac and noncardiac operations. Ann Thorac Surg. 2012;94:1761–81.CrossRef
15.
Zurück zum Zitat Tokushige A, Shiomi H, Morimoto T, Furukawa Y, Nakagawa Y, Kadota K, et al. Incidence and outcome of surgical procedures after coronary bare-metal and drug-eluting stent implantation: a report from the CREDO-Kyoto PCI/CABG registry cohort-2. Circ Cardiovasc Interv. 2012;5:237–46.CrossRef Tokushige A, Shiomi H, Morimoto T, Furukawa Y, Nakagawa Y, Kadota K, et al. Incidence and outcome of surgical procedures after coronary bare-metal and drug-eluting stent implantation: a report from the CREDO-Kyoto PCI/CABG registry cohort-2. Circ Cardiovasc Interv. 2012;5:237–46.CrossRef
16.
Zurück zum Zitat Yu WS, Jung HS, Lee JG, Kim DJ, Chung KY, Lee CY. Safety of thoracoscopic surgery for lung cancer without interruption of anti-platelet agents. J Thorac Dis. 2015;7:2024–32.PubMedPubMedCentral Yu WS, Jung HS, Lee JG, Kim DJ, Chung KY, Lee CY. Safety of thoracoscopic surgery for lung cancer without interruption of anti-platelet agents. J Thorac Dis. 2015;7:2024–32.PubMedPubMedCentral
17.
Zurück zum Zitat Cruden NLM, Harding SA, Flapan AD, Graham C, Wild SH, Slack R, et al. Previous coronary stent implantation and cardiac events in patients undergoing noncardiac surgery. Circ Cardiovasc Interv. 2010;3:236–42.CrossRef Cruden NLM, Harding SA, Flapan AD, Graham C, Wild SH, Slack R, et al. Previous coronary stent implantation and cardiac events in patients undergoing noncardiac surgery. Circ Cardiovasc Interv. 2010;3:236–42.CrossRef
18.
Zurück zum Zitat Wijeysundera DN, Wijeysundera HC, Yun L, Wasowicz M, Beattie WS, Velianou JL, et al. Risk of elective major noncardiac surgery after coronary stent insertion: a population-based study. Circulation. 2012;126:1355–62.CrossRef Wijeysundera DN, Wijeysundera HC, Yun L, Wasowicz M, Beattie WS, Velianou JL, et al. Risk of elective major noncardiac surgery after coronary stent insertion: a population-based study. Circulation. 2012;126:1355–62.CrossRef
19.
Zurück zum Zitat Kheiri B, Osman M, Abdalla A, Haykal T, Swaid B, Ahmed S, et al. Clopidogrel and aspirin after ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis of randomized clinical trials. J Thromb Thrombolysis. 2019;47:233–47.CrossRef Kheiri B, Osman M, Abdalla A, Haykal T, Swaid B, Ahmed S, et al. Clopidogrel and aspirin after ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis of randomized clinical trials. J Thromb Thrombolysis. 2019;47:233–47.CrossRef
20.
Zurück zum Zitat Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med. 2018;379:215–25.CrossRef Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med. 2018;379:215–25.CrossRef
21.
Zurück zum Zitat Sonobe M, Sato T, Chen F, Fujinaga T, Shoji T, Sakai H, et al. Management of patients with coronary stents in elective thoracic surgery. Gen Thorac Cardiovasc Surg. 2011;59:477–82.CrossRef Sonobe M, Sato T, Chen F, Fujinaga T, Shoji T, Sakai H, et al. Management of patients with coronary stents in elective thoracic surgery. Gen Thorac Cardiovasc Surg. 2011;59:477–82.CrossRef
22.
Zurück zum Zitat Yasukawa M, Taiji R, Marugami N, Kawaguchi T, Kawai N, Sawabata N, et al. Ultrasonography for Detecting Adhesions: Aspirin Continuation for Lung Resection Patients. Vivo. 2019;33:973–8.CrossRef Yasukawa M, Taiji R, Marugami N, Kawaguchi T, Kawai N, Sawabata N, et al. Ultrasonography for Detecting Adhesions: Aspirin Continuation for Lung Resection Patients. Vivo. 2019;33:973–8.CrossRef
Metadaten
Titel
Continuation of aspirin perioperatively for lung resection: a propensity matched analysis
verfasst von
Takashi Sakai
Keiju Aokage
Shinya Katsumata
Kenta Tane
Tomohiro Miyoshi
Masahiro Tsuboi
Publikationsdatum
03.01.2021
Verlag
Springer Singapore
Erschienen in
Surgery Today / Ausgabe 6/2021
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-020-02202-4

Weitere Artikel der Ausgabe 6/2021

Surgery Today 6/2021 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.