• Takahisa Fujikawa, Suguru Hasegawa, Ryo Takahashi, Shigetoshi Naito, Satoshi Kaihara, Kenji Uryuhara, Keiji Hirata, Toshihisa Tamura, Hiroaki Terajima, Takayuki Kawai, Hiroshi Okabe, Takafumi Machimoto, Hirokazu Tanaka, Shusaku Honma, Katsuyoshi Furumoto, Goro Honda, Shuichiro Uemura, Ryuta Nishitai, Koya Hida, Ryuhei Aoyama, Seidai Wada, Tetsuro Hirose, and Kazutaka Obama.
• Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.
• Ann. Surg. 2023 Oct 23.

ObjectiveThis study aimed to evaluate the effect of continuing preoperative aspirin monotherapy on surgical outcomes in patients receiving antiplatelet therapy (APT).Summary Background DataThe effectiveness of continuing preoperative aspirin monotherapy in patients undergoing APT in preventing thromboembolic consequences is mostly unknown.MethodsThis prospective multicenter cohort study on the Safety and Feasibility of Gastroenterological Surgery in Patients Undergoing Antithrombotic Therapy (GSATT study) conducted at 14 clinical centers enrolled and screened patients between October 2019 and December 2021. The participants (n=1,170) were assigned to the continued APT group, discontinued APT group, or non-APT group, and the surgical outcomes of each group were compared. Propensity score matching was performed between the continued and discontinued APT groups to investigate the effect of continuing preoperative aspirin therapy on thromboembolic complications.ResultsThe rate of thromboembolic complications in the continued APT group was substantially lower than that in the non-APT or discontinued APT groups (0.5% vs. 2.6% vs. 2.9%; P=0.027). Multivariate investigation of the entire cohort revealed that discontinuation of APT (P<0.001) and chronic anticoagulant use (P<0.001) were independent risk factors for postoperative thromboembolism. The post-matching evaluation demonstrated that the rates of thromboembolic complications were significantly different between the continued and discontinued APT groups (0.6% vs. 3.3%; P=0.012).ConclusionsAPT discontinuation following elective gastroenterological surgery increases the risk of thromboembolic consequences, whereas continuing preoperative aspirin greatly reduces this risk. The continuation of preoperative aspirin therapy in APT-received patients is considered one of the best alternatives for preventing thromboembolism during elective gastroenterological surgery.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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