title: Risk is not our business: safety of thoracic surgery in patients using antiplatelet therapy.
abstract: American Heart Association recommendations have changed preoperative management of patients with antiplatelet therapy (APT). We assessed safety and outcomes of surgery in patients who were receiving APT. A prospective study of patients operated on while receiving APT was matched with those with no APT (ratio 1:4), using the propensity score method. Logistic regression analysis was used to identify covariates among imbalanced baseline patient variables. Both χ(2) test and Fisher's test were used to calculate the probability value for the comparison of dichotomous variables. Between January 2008 and December 2010, 38 patients who received APT at the time of surgery were matched with 141 patients who had not received APT. APT indications were a history of myocardial infarction, coronary artery by-pass graft and/or valve replacement (19), coronary artery stent (11) and severe peripheral vascular disease (8). None of the patients required re-operation for bleeding. Two patients received blood transfusions. The amount of chest tube drainage was not statistically significantly different. There were no statistically significant differences between the outcomes for the operative time, length of hospital stay, estimated blood loss or morbidity. The results show that thoracic surgical procedures can safely be performed in patients receiving APT at the time of surgery, with no increased risk of bleeding or morbidity and no differences in the operative time and the length of hospital stay.
authors.affiliation: Thoracic Surgery Unit, S. Croce e Carle City Hospital, Cueno, Italy. luca.bertolaccini@unito.it
authors.forename: Luca
authors.initials: L
authors.lastname: Bertolaccini
authors.forename: Alberto
authors.initials: A
authors.lastname: Terzi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Rizzardi
authors.forename: Alberto
authors.initials: A
authors.lastname: Gorla
authors.forename: Andrea
authors.initials: A
authors.lastname: Viti
authors.forename: Sarah
authors.initials: S
authors.lastname: Palmisano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Coletta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004322:Drainage; D005260:Female; D006801:Humans; D007558:Italy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D057216:Propensity Score; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors