Preoperative aspirin reduces thrombosis risk in abdominal malignancy surgery

A new study published in the Journal of Anesthesia has reported that continuation of aspirin administration is likely to reduce the thrombotic risk but unlikely to increase the bleeding risk of patients who undergo major abdominal surgery for malignancy.

Previous reports have provided substantial evidence that aspirin reduces the incidence of thromboembolic events in a nonoperative setting. According to the authors, in contrast to that in a nonoperative setting, it has been shown that perioperative administration of aspirin did not decrease the rate of death or myocardial infarction but increased major bleeding risk. Researchers suggested that the conflicting results might be due to concurrent use of anticoagulants and a lower thrombotic risk of patients.

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This has created a situation of a dilemma in clinicians whether to continue or discontinue aspirin administration in the perioperative period. To have a more clear perspective over this contradictory result, Kazumi Ono and his colleagues performed a cohort study for patients at a high thrombotic risk without concurrent use of anticoagulants.

The investigators reviewed the medical records for patients who underwent major abdominal malignancy surgery and who were on a preoperative antiplatelet regimen.

The study participants were divided into two groups according to perioperative antiplatelet management: administration of all preoperative antiplatelet agent-suspended (no aspirin) group and only aspirin administration-continued (aspirin) group.

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The incidence of symptomatic thromboembolic events, the frequency of exogenous blood transfusion within 30 days after surgery and the amount of intraoperative bleeding were compared between the two groups.

The study found that the incidence of perioperative thromboembolic events in the no-aspirin group was significantly higher than that in the aspirin group 6.7% vs 0%].

In contrast, neither the frequency of exogenous transfusion nor the amount of intraoperative bleeding was different between the two groups.

The study concluded that the preoperative continuation of aspirin administration is likely to be effective for reducing the thrombotic risk but is unlikely to increase the bleeding risk in patients undergoing major abdominal surgery for malignancy without concomitant use of anticoagulants.

For full information log on to https://link.springer.com/article/10.1007/s00540-018-2591-8