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Continued Antiplatelet Therapy and Risk of Bleeding in Gastrointestinal Procedures: A Systematic Review.
- Source :
-
Journal of the American College of Surgeons [J Am Coll Surg] 2016 May; Vol. 222 (5), pp. 890-905.e11. Date of Electronic Publication: 2016 Feb 06. - Publication Year :
- 2016
-
Abstract
- Background: Management of perioperative antiplatelet medications in gastrointestinal (GI) surgery is challenging. The risk of intraoperative and postoperative bleeding is associated with perioperative use of antiplatelet medication. However, cessation of these drugs may be unsafe for patients who are required to maintain antiplatelet use due to cardiovascular conditions. The objective of this systematic review was to compare the risk of intraoperative or postoperative bleeding among patients who had GI surgery while on continuous antiplatelet therapy (aspirin, clopidogrel, or dual therapy) with the risk among those not taking continuous antiplatelet medication.<br />Study Design: We reviewed articles published between January 2000 and July 2015 from the Medline Ovid and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Studies involving any GI procedures were included if the articles met our inclusion criteria (listed in Methods). The following key words were used for the search: clopidogrel, Plavix, aspirin, antiplatelet, bleeding, hemorrhage, and digestive system surgical procedures. Quality of the studies was assessed, depending on their study design, using the Newcastle-Ottawa score or the Cochrane Collaboration's tool for assessing risk of bias.<br />Results: Twenty-two studies were eligible for inclusion in the systematic review. Five showed that the risk of intraoperative bleeding or postoperative bleeding among patients who had GI surgery while on continuous antiplatelet therapy was higher compared that for those not on continuous therapy. The remaining 17 studies reported that there was no statistically significant difference in the risks of bleeding between the continuous antiplatelet therapy group and the group without continuous antiplatelet therapy.<br />Conclusions: The risk of bleeding associated with GI procedures in patients receiving antiplatelet therapy was not significantly higher than in patients with no antiplatelet or interrupted antiplatelet therapy.<br /> (Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Endoscopy, Digestive System adverse effects
Humans
Intraoperative Complications chemically induced
Intraoperative Complications etiology
Platelet Aggregation Inhibitors administration & dosage
Postoperative Complications chemically induced
Postoperative Complications etiology
Postoperative Hemorrhage chemically induced
Quality Assurance, Health Care
Risk Assessment
Digestive System Surgical Procedures adverse effects
Herniorrhaphy adverse effects
Platelet Aggregation Inhibitors adverse effects
Postoperative Hemorrhage etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1190
- Volume :
- 222
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 27016908
- Full Text :
- https://doi.org/10.1016/j.jamcollsurg.2016.01.053