Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris (AP-HP) Hôpital Paul-Brousse, Villejuif, France.
Institut National de la Santé et de la Recherche Médicale, Unité 1193, Université Paris-Saclay, Villejuif, France.
Br J Surg. 2018 Mar;105(4):429-438. doi: 10.1002/bjs.10697. Epub 2018 Feb 7.
The 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.
Data 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.
Before 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 (6·5 versus 5·6 per cent respectively; odds ratio (OR) 1·18, 95 per cent c.i. 0·38 to 3·62), intraoperative transfusion (23·4 versus 23·7 per cent; OR 0·98, 0·51 to 1·87), overall haemorrhage (10·2 versus 12·0 per cent; OR 0·83, 0·35 to 1·94), CCI score (24 versus 28; P = 0·520), major complications (23·1 versus 13·9 per cent; OR 1·82, 0·92 to 3·79) and 90-day mortality (5·6 versus 4·6 per cent; OR 1·21, 0·36 to 4·09).
This observational study suggested that aspirin continuation is not associated with a higher rate of bleeding-related complications after elective hepatic surgery.
在抗血小板治疗下进行肝切除术的手术风险尚不清楚。本研究旨在评估在均衡匹配队列中，继续使用或不继续使用阿司匹林进行择期肝切除术的结果。
从一项多中心前瞻性观察性研究中检索数据。通过非标准化方法和倾向评分（PS）匹配分析比较阿司匹林组和对照组。主要结局是严重（Dindo-Clavien 分级 IIIa 或更高）出血。其他分析的结果包括术中输血、总出血、主要并发症、综合并发症指数（CCI）评分、血栓栓塞并发症、缺血性并发症和死亡率。
在匹配前，阿司匹林组有 118 例患者，对照组有 1685 例患者。ASA 体能状况评分、心血管疾病、既往心绞痛史、血管成形术、糖尿病、使用维生素 K 拮抗剂、肝硬化和肝切除术类型在两组之间差异有统计学意义。PS 匹配后，每组纳入 108 例患者。阿司匹林组和对照组在严重出血（分别为 6.5%和 5.6%；比值比（OR）1.18，95%置信区间 0.38 至 3.62）、术中输血（23.4%和 23.7%；OR 0.98，0.51 至 1.87）、总出血（10.2%和 12.0%；OR 0.83，0.35 至 1.94）、CCI 评分（24 与 28；P=0.520）、主要并发症（23.1%和 13.9%；OR 1.82，0.92 至 3.79）和 90 天死亡率（5.6%和 4.6%；OR 1.21，0.36 至 4.09）方面无统计学差异。
本观察性研究表明，在择期肝外科手术中，继续使用阿司匹林与出血相关并发症发生率增加无关。
