Use of aspirin and bleeding-related complications after hepatic resection
Résumé
BackgroundThe operative risk of hepatectomy under antiplatelet therapy is unknown. This study sought to assess the outcomes of elective hepatectomy performed with or without aspirin continuation in a well balanced matched cohort. MethodsData were retrieved from a multicentre prospective observational study. Aspirin and control groups were compared by non-standardized methods and by propensity score (PS) matching analysis. The main outcome was severe (Dindo-Clavien grade IIIa or more) haemorrhage. Other outcomes analysed were intraoperative transfusion, overall haemorrhage, major morbidity, comprehensive complication index (CCI) score, thromboembolic complications, ischaemic complications and mortality. ResultsBefore matching, there were 118 patients in the aspirin group and 1685 in the control group. ASA fitness grade, cardiovascular disease, previous history of angina pectoris, angioplasty, diabetes, use of vitamin K antagonists, cirrhosis and type of hepatectomy were significantly different between the groups. After PS matching, 108 patients were included in each group. There were no statistically significant differences between the aspirin and control groups in severe haemorrhage (65 versus 56 per cent respectively; odds ratio (OR) 118, 95 per cent c.i. 038 to 362), intraoperative transfusion (234 versus 237 per cent; OR 098, 051 to 187), overall haemorrhage (102 versus 120 per cent; OR 083, 035 to 194), CCI score (24 versus 28; P = 0520), major complications (231 versus 139 per cent; OR 182, 092 to 379) and 90-day mortality (56 versus 46 per cent; OR 121, 036 to 409). ConclusionThis observational study suggested that aspirin continuation is not associated with a higher rate of bleeding-related complications after elective hepatic surgery. No increased risk