Canu Gian Luigi, Medas Fabio, Cappellacci Federico, Giordano Alessio Biagio Filippo, Casti Francesco, Grifoni Lucrezia, Feroci Francesco, Calò Pietro Giorgio
Department of Surgical Sciences, University of Cagliari, Monserrato, CA, Italy.
Department of General and Oncologic Surgery, Santo Stefano Hospital, Prato, PO, Italy.
Front Surg. 2022 Nov 4;9:1046561. doi: 10.3389/fsurg.2022.1046561. eCollection 2022.
A growing number of patients taking antiplatelet drugs, mainly low-dose acetylsalicylic acid (ASA) (75-150 mg/day), for primary or secondary prevention of thrombotic events, are encountered in every field of surgery. While the bleeding risk due to the continuation of these medications during the perioperative period has been adequately investigated in several surgical specialties, in thyroid surgery it still needs to be clarified. The main aim of this study was to assess the occurrence of cervical haematoma in patients receiving low-dose acetylsalicylic acid, specifically ASA 100 mg/day, during the perioperative period of thyroidectomy.
Patients undergoing thyroidectomy in two high-volume thyroid surgery centers in Italy, between January 2021 and December 2021, were retrospectively analysed. Enrolled patients were divided into two groups: those not taking ASA were included in Group A, while those receiving this drug in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analysis was employed to evaluate the use of low-dose ASA as independent risk factor for cervical haematoma.
A total of 412 patients underwent thyroidectomy during the study period. Among them, 29 (7.04%) were taking ASA. Based on the inclusion criteria, 351 patients were enrolled: 322 were included in Group A and 29 in Group B. In Group A, there were 4 (1.24%) cervical haematomas not requiring surgical revision of haemostasis and 4 (1.24%) cervical haematomas requiring surgical revision of haemostasis. In Group B, there was 1 (3.45%) cervical haematoma requiring surgical revision of haemostasis. At univariate analysis, no statistically significant difference was found between the two groups in terms of occurrence of cervical haematoma, nor of the other early complications of thyroidectomy. At multivariate analysis, the use of low-dose ASA did not prove to be an independent risk factor for cervical haematoma.
Based on our findings, we believe that in patients receiving this drug, either for primary or secondary prevention of thrombotic events, its discontinuation during the perioperative period of thyroidectomy is not necessary.
在外科手术的各个领域，越来越多服用抗血小板药物（主要是低剂量阿司匹林（ASA），75 - 150毫克/天）用于血栓形成事件一级或二级预防的患者被发现。虽然在几个外科专科中，围手术期继续使用这些药物导致的出血风险已得到充分研究，但在甲状腺手术中仍需阐明。本研究的主要目的是评估在甲状腺切除围手术期接受低剂量阿司匹林（具体为100毫克/天的ASA）的患者中颈部血肿的发生率。
对2021年1月至2021年12月期间在意大利两个高容量甲状腺手术中心接受甲状腺切除术的患者进行回顾性分析。纳入的患者分为两组：未服用ASA的患者纳入A组，服用该药物的患者纳入B组。进行单因素分析以比较这两组。此外，采用多因素分析来评估低剂量ASA的使用作为颈部血肿独立危险因素的情况。
在研究期间，共有412例患者接受了甲状腺切除术。其中，29例（7.04%）正在服用ASA。根据纳入标准，351例患者被纳入研究：322例纳入A组，29例纳入B组。在A组中，有4例（1.24%）颈部血肿无需手术止血修正，4例（1.24%）颈部血肿需要手术止血修正。在B组中，有1例（3.45%）颈部血肿需要手术止血修正。在单因素分析中，两组在颈部血肿发生率以及甲状腺切除的其他早期并发症方面均未发现统计学上的显著差异。在多因素分析中，低剂量ASA的使用并未被证明是颈部血肿的独立危险因素。
基于我们的研究结果，我们认为对于服用该药物用于血栓形成事件一级或二级预防的患者，在甲状腺切除围手术期无需停用。
