Departments of Surgery, Nara Medical University, Nara, Japan.
Departments of Surgery, Nara Medical University, Nara, Japan.
J Am Coll Surg. 2020 Oct;231(4):460-469.e1. doi: 10.1016/j.jamcollsurg.2020.06.017. Epub 2020 Jul 4.
This retrospective multicenter study aimed to evaluate the risk of postpancreatectomy hemorrhage (PPH) in patients receiving antithrombotic agents (ATAs). PPH is the most severe complication after pancreatectomy. However, there is little known about the strength of the association between ATA use, PPH, and other clinical outcomes.
Between 2007 and 2016, 1,297 patients underwent pancreatectomy at 2 surgical centers. ATA use included aspirin, clopidogrel, ticlopidine, warfarin, direct oral anticoagulants, and intravenous unfractionated heparin. The ATA group was composed of 144 patients who were taking ATAs before surgery.
A total of 35 patients developed PPH. The patients in the ATA group showed higher frequency (8.3% vs 2.0%, p < 0.001) of PPH compared with the control group (n = 1,153). In multivariate analysis, ATA use was an independent adverse risk factor for PPH (odds ratio [OR] 3.58, 95% CI 1.29-9.91, p = 0.014). Stratification by preoperative ATA therapy revealed a significant risk of PPH Grade C in patients receiving combined AT therapy. The median onset of late hemorrhage (>24 hours post-surgery) in the ATA group was later than in the control group (17.5 vs 8.5 days, p = 0.032), and the incidence tended to be higher in patients who restarted ATAs postoperatively.
History of ATA use is a significant risk factor for PPH, and postoperative resumption of ATAs appears to be associated with an increased risk of PPH. Patients receiving combined antithrombotic therapy may be at particularly high risk for PPH.
本回顾性多中心研究旨在评估接受抗血栓药物（ATAs）治疗的患者发生胰切除术后出血（PPH）的风险。PPH 是胰切除术后最严重的并发症。然而，关于 ATA 使用、PPH 与其他临床结局之间关联的强度知之甚少。
2007 年至 2016 年期间，有 2 家外科中心的 1297 名患者接受了胰切除术。ATA 使用包括阿司匹林、氯吡格雷、噻氯匹定、华法林、直接口服抗凝剂和静脉普通肝素。ATA 组由 144 名术前服用 ATA 的患者组成。
共有 35 名患者发生 PPH。ATA 组患者 PPH 的发生率更高（8.3%比 2.0%，p<0.001），与对照组（n=1153）相比。多变量分析显示，ATA 使用是 PPH 的独立不良危险因素（比值比[OR]3.58，95%置信区间 1.29-9.91，p=0.014）。术前 ATA 治疗分层显示，联合 ATA 治疗的患者 PPH C 级的风险显著增加。ATA 组的迟发性出血（术后>24 小时）中位发病时间晚于对照组（17.5 天比 8.5 天，p=0.032），术后重新开始使用 ATA 的患者出血发生率更高。
ATA 使用史是 PPH 的显著危险因素，术后重新开始使用 ATA 似乎与 PPH 风险增加相关。接受联合抗血栓治疗的患者可能面临特别高的 PPH 风险。
