Digestive Surgery in Patients Treated with Antiplatelet Agents: How Risky?

Purpose: To assess the risks of digestive surgery in patients under antiplatelet therapy. Increasing numbers of patients requiring a surgical digestive procedure are on APT. Several studies have shown that APT interruption during the perioperative period increased thrombotic risks, while in the case of maintaining APT, hemorrhagic complications were not increased. Methods: We included prospectively all patients under APT who were operated on from September 1, 2010 to October 31, 2011. Two groups were defined: patients who interrupted APT and those who maintained APT. Three surgical categories were distinguished, with Group I involving parietal surgery, Group II common abdominal surgery, and Group III complex abdominal surgery. The primary endpoints were hemorrhagic and thrombotic risks. Results: Among the 2047 patients undergoing digestive surgery, 130 (6.5%) were on APT, with 32 in Group APT- and 98 in Group APT+. In the overall series, patients taking APT did not receive significantly more transfusions. APT was significantly associated with a higher rate of bleeding complications and transfusion requirement in patients undergoing complex and major abdominal surgery (0% vs. 28%, p = 0.03). In Group APT-, only one patient out of 32 (3.1%) suffered from a thrombotic event involving a myocardial infarction. Conclusions: This study suggests stopping APT at least 5 - 7 days in patients undergoing complex and major abdominal surgery. In this other case, APT may be maintained without an increased risk of hemorrhage.