title: Anti-platelet therapy: no association with increased blood loss in patients undergoing open or laparoscopic appendectomy.
abstract: BACKGROUND
  The effect of anti-platelet drugs on surgical blood loss and perioperative complications has not been studied in depth and the management of surgical patients taking anti-platelet medications is controversial.
  
  
  OBJECTIVE
  To assess the effect of anti-platelet therapy on perioperative blood loss in patients undergoing appendectomy either laparoscopically or via open surgery.
  
  
  METHODS
  We reviewed the files of all patients 40 years old who underwent open or laparoscopic appendectomies from 2007 to 2010. Excluded were patients with short hospitalization and no follow-up of hemoglobin level, patients on warfarin treatment and patients who underwent additional procedures. Estimation of blood loss was based on decrease in hemoglobin level from admission to discharge. Risk factors for blood loss, such as anti-platelet therapy, age, gender, surgical approach, surgical time, surgical findings and complications, were analyzed.
  
  
  RESULTS
  The final cohort included 179 patients (mean age 61 +/- 14 years, range 40-93) of whom 65 were males. The mean perioperative hemoglobin decrease was 1.59 +/- 1.07 mg/dl (range 0-5 mg/dl). Thirty-nine patients received anti-platelet therapy prior to surgery and 140 did not. No significant differences in decrease of hemoglobin level were found between patients receiving anti-platelet therapy and those who were not (1.73 +/- 1.21 vs. 1.55 +/- 1.02 mg/dl, P = 0.3). In addition, no difference was found between patients on anti-platelettherapy operated laparoscopically and those operated in an open fashion (1.59 +/- 1.18 vs. 2.04 +/- 1.28 mg/ dl, P = 0.29). Five patients required blood transfusions, two of whom were on anti-platelet therapy. Blood loss was significantly greater in patients with a perforated appendicitis and in those with an operative time of more than one hour.
  
  
  CONCLUSIONS
  Anti-platelet therapy does not pose a risk for increased blood loss following emergent appendectomy performed either laparoscopically or in an open fashion.
authors.affiliation: Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. ofirchik@yahoo.com
authors.forename: Ofir
authors.initials: O
authors.lastname: Chechik
authors.forename: Roy
authors.initials: R
authors.lastname: Inbar
authors.forename: Barry
authors.initials: B
authors.lastname: Danino
authors.forename: Ran
authors.initials: R
authors.lastname: Lador
authors.forename: Ron
authors.initials: R
authors.lastname: Greenberg
authors.forename: Shmuel
authors.initials: S
authors.lastname: Avital
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000097:blood / Q000150:complications / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010976:Platelet Count; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors