Postoperative bleeding complications after gastric cancer surgery in patients receiving anticoagulation and/or antiplatelet agents.
BACKGROUND
Perioperative antithrombotic treatment for gastric cancer patients receiving chronic anticoagulation and/or antiplatelet agents requires an understanding of potential bleeding and thromboembolic risks. However, no study has examined the safety aspects of perioperative antithrombotic treatment during radical gastrectomy. This study sought to evaluate postoperative bleeding and thromboembolic complications after radical gastrectomy in patients undergoing perioperative antithrombotic treatment.


METHODS
The medical records of patient treated by radical gastrectomy from January 2006 to December 2010 were retrospectively reviewed. Those in the thromboprophylaxis group had received one of three regimens of perioperative antithrombotic treatment according to the clinical indications of chronic anticoagulation and/or antiplatelet agents and several published evidence-based recommendations: (1) bridging therapy with unfractionated heparin; (2) continuation of aspirin; or (3) both 1 and 2. multivariate analysis was used to identify risk factors for postoperative bleeding complications after radical gastrectomy.


RESULTS
During the study period, 340 patients underwent radical gastrectomy. Of these, 62 patients received perioperative antithrombotic treatment; this thromboprophylaxis group had a significantly higher postoperative bleeding rate (8.1 vs. 0.7 %, P = 0.003). However, other complications, including thromboembolic events, were similar in the two study groups. Multivariate analysis revealed that perioperative antithrombotic treatment was the only independent risk factor of postoperative bleeding complications after radical gastrectomy (odds ratio, 8.53; 95 % confidence interval, 1.47-49.39; P = 0.017).


CONCLUSIONS
Perioperative antithrombotic treatment is an independent risk factor of postoperative bleeding complications in patients with gastric cancer undergoing radical gastrectomy, although such treatment was effective in preventing postoperative thromboembolic events.
Department of Surgery, New-Tokyo Hospital, Matudo, Chiba, Japan. kazumitatantan@yahoo.co.jp
Kazuhito
K
Mita
Hideto
H
Ito
Ryo
R
Murabayashi
Kouichirou
K
Sueyoshi
Hideki
H
Asakawa
Masashi
M
Nabetani
Akira
A
Kamasako
Kazuya
K
Koizumi
Takashi
T
Hayashi
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009367:Neoplasm Staging; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D013923:Thromboembolism / Q000188:drug therapy* / Q000209:etiology
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors