K. Akahoshi1, T. Ochiai1, S. Matsumura1, A. Aihara1, D. Ban1, T. Irie1, A. Kudo1, S. Tanaka1, M. Tanabe1 1Tokyo Medical And Dental University,Department Of Hepato-Biliary-Pancreatic Surgery,Bunkyo-ku, Tokyo, Japan
Introduction: Patients receiving anticoagulant and/or antiplatelet therapy are increasing with aging of the society. In case of emergent surgery, if they continue taking anticoagulant and/or antiplatelet therapy up to the time of surgery, they face an increased risk of bleeding. Therefore, most patients need to bridge with heparin or to discontinue it before surgery. However, some patients don’t have adequate time to weaken the antiplatelet effect, or need to continue it to avoid thrombosis. We retrospectively studied the acute cholecystitis patients on anticoagulant and/or antiplatelet therapy and report the introduction of hemostatic techniques for liver surgery into the acute cholecystitis patients on anticoagulant and/or antiplatelet therapy.
Methods: Between 2008 and 2013, 85 patients were performed cholecystectomy for acute cholecystitis in our hospital and 18 patients were on anticoagulant and/or antiplatelet therapy. The medical records of 85 patients were retrospectively reviewed.
Results:Of the 18 patients, 9 were on antiplatelet, 5 were on anticoagulant and 4 were on both anticoagulant and antiplatelet. Prior to emergent surgery, anticoagulant and/or antiplatelet were discontinued in 2 patients, bridged with heparin in 8 and continued in 7. The average amounts of blood loss of those who discontinued the anticoagulant and/or antiplatelet, bridged with heparin and continued were 289ml, 283ml and 528ml, respectively. Among all 85 patients of acute cholecystectomy, intraoperative bleeding more than 1000ml occurred in 29% (2 of 7) of the patients who continued antiplatelet therapy, 13% (1 of 8) of heparinization group and 2.9% (2 of 68) of control group. In addition, hemostatic agents such as Tachocomb and hemostatic devices such as TissueLink dissecting sealer were effective to control the bleeding from liver bed. No postoperative hemorrhage was confirmed in this study.
Conclusion:The risk of intraoperative bleeding increased when anticoagulant and/or antiplatelet therapy was continued. In our experiences, hemostatic techniques for liver surgery, such as hemostatic agents and TissueLink dissecting sealer, are effective to control intraoperative and postoperative bleeding.