Department of Surgery, Spectrum Health, Grand Rapids, MI.
Department of Surgery and the Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
Surgery. 2014 Jan;155(1):39-46. doi: 10.1016/j.surg.2013.05.031. Epub 2013 Jul 24.
Antiplatelet therapy with aspirin is prevalent among patients presenting for operative treatment of pancreatic disorders. Operative practice has called for the cessation of aspirin 7-10 days before elective procedures because of the perceived increased risk of procedure-related bleeding. Our practice at Thomas Jefferson University has been to continue aspirin therapy throughout the perioperative period in patients undergoing elective pancreatic surgery.
Records for patients undergoing pancreatoduodenectomy, distal pancreatectomy, or total pancreatectomy between October 2005 and February 2012 were queried for perioperative aspirin use in this institutional research board-approved retrospective study. Statistical analyses were performed with Stata software.
During the study period, 1,017 patients underwent pancreatic resection, of whom 289 patients (28.4%) were maintained on aspirin through the morning of the operation. Patients in the aspirin group were older than those not taking aspirin (median 69 years vs 62 years, P < .0001). The estimated intraoperative blood loss was similar between the two groups, aspirin versus no aspirin (median 400 mL vs 400 mL, P = .661), as was the rate of blood transfusion anytime during the index admission (29% vs 26%, P = 0.37) and the postoperative duration of hospital stay (median 7 days vs 6 days, P = .103). The aspirin group had a slightly increased rate of cardiovascular complications (10.1% vs 7.0%, P = .107), likely reflecting their increased cardiovascular comorbidities that led to their physicians recommending aspirin therapy. Rates of pancreatic fistula (15.1% vs 13.5%, P = .490) and hospital readmissions were similar (16.9% vs 14.9%, P = .451).
This is the first study to report that aspirin therapy is not associated with increased rates of perioperative bleeding, transfusion requirement, or major procedure related complications after elective pancreatic surgery. These data suggest that continuation of aspirin is safe and that the continuation of aspirin should be considered acceptable and preferable, particularly in patients with perceived substantial medical need for treatment with antiplatelet therapy.
在因胰腺疾病接受手术治疗的患者中，普遍采用阿司匹林进行抗血小板治疗。由于手术相关出血风险增加，手术实践要求在择期手术前 7-10 天停止使用阿司匹林。在托马斯杰斐逊大学，我们的手术实践是在接受择期胰腺手术的患者围手术期继续使用阿司匹林。
在这项机构研究委员会批准的回顾性研究中，检索了 2005 年 10 月至 2012 年 2 月期间行胰十二指肠切除术、胰体尾切除术或全胰切除术患者的病历，以确定围手术期阿司匹林的使用情况。使用 Stata 软件进行统计分析。
研究期间，1017 例患者接受了胰腺切除术，其中 289 例（28.4%）患者在手术当天早上继续服用阿司匹林。阿司匹林组患者比未服用阿司匹林的患者年龄更大（中位数 69 岁比 62 岁，P<0.0001）。两组术中估计失血量相似（中位数 400 mL 比 400 mL，P=0.661），任何时候输血率相似（29%比 26%，P=0.37），术后住院时间中位数也相似（7 天比 6 天，P=0.103）。阿司匹林组心血管并发症发生率略高（10.1%比 7.0%，P=0.107），这可能反映了导致其医生建议使用阿司匹林治疗的患者心血管合并症增加。胰瘘发生率（15.1%比 13.5%，P=0.490）和再次住院率相似（16.9%比 14.9%，P=0.451）。
这是第一项报告阿司匹林治疗与择期胰腺手术后围手术期出血、输血需求或主要手术相关并发症发生率增加无关的研究。这些数据表明，继续使用阿司匹林是安全的，并且继续使用阿司匹林应该是可以接受的和可取的，特别是在有抗血小板治疗实际医疗需求的患者中。
Zotero 插件