Department of Surgery, Kokura Memorial Hospital, Fukuoka, Japan.
Department of Gastroenterological Surgery, Fukuoka University, Fukuoka, Japan.
J Hepatobiliary Pancreat Sci. 2020 Nov;27(11):830-838. doi: 10.1002/jhbp.735. Epub 2020 May 3.
There is insufficient evidence concerning the effect of preoperative continuation of antiplatelet therapy (APT) on intraoperative and postoperative bleeding during liver resection. This study investigated the efficacy and safety of preoperative aspirin continuation on bleeding complications during or after liver resection using propensity score matching (PSM).
Between 2005 and 2018, 425 patients who underwent liver resection were enrolled in this study. Patients were divided into two groups; the cAPT group received continued aspirin monotherapy preoperatively (n = 63) and the control group did not (n = 362). Propensity score matching was performed based on the preoperative clinical parameters. Intraoperative and postoperative complications, including bleeding complications, were compared between groups.
After propensity score matching, 126 patients were included in the analysis (cAPT group, n = 63 and control group, n = 63). There were no differences in patients' background characteristics, and intraoperative blood loss was identical between the groups (200 vs 180 mL, P = .54). The frequency of postoperative complications (Clavien-Dindo class 2 or higher, 13/63 [20.6%] vs 13/63 [20.6%], P = 1.00) and postoperative hemorrhagic complication (3/63 [4.8%] vs 3/63 [4.8%], P = 1.00) was also similar between the groups; no difference was observed in the length of postoperative stay (11 days vs 14 days, P = .08).
Preoperative continuation of aspirin monotherapy does not affect intraoperative or postoperative bleeding in patients receiving liver resection. Either open or laparoscopic liver resection can be safely performed in patients with continued aspirin therapy.
关于肝切除术中及术后继续使用抗血小板治疗（APT）对术中及术后出血的影响，目前证据不足。本研究通过倾向评分匹配（PSM）探讨肝切除术前继续使用阿司匹林对出血并发症的疗效和安全性。
2005 年至 2018 年，共纳入 425 例接受肝切除术的患者。将患者分为两组：cAPT 组术前继续接受阿司匹林单药治疗（n=63），对照组不接受（n=362）。根据术前临床参数进行倾向评分匹配。比较两组术中及术后并发症，包括出血并发症。
经倾向评分匹配后，共纳入 126 例患者（cAPT 组，n=63；对照组，n=63）。两组患者的背景特征无差异，术中出血量也相同（200 比 180 毫升，P=0.54）。两组术后并发症（Clavien-Dindo 分级 2 级或以上，13/63 [20.6%]比 13/63 [20.6%]，P=1.00）和术后出血性并发症（3/63 [4.8%]比 3/63 [4.8%]，P=1.00）的发生率也相似；术后住院时间也无差异（11 天比 14 天，P=0.08）。
肝切除术前继续使用阿司匹林单药治疗不会影响术中或术后出血。在继续阿司匹林治疗的患者中，可以安全地进行开放或腹腔镜肝切除术。
