Department of Surgery, Huanggang Central Hospital of Yangtze University, 438000, Huanggang, Hubei, People's Republic of China.
The Outpatient Department, Huanggang Central Hospital of Yangtze University, 438000, Huanggang, Hubei, People's Republic of China.
Updates Surg. 2024 Sep;76(5):1669-1683. doi: 10.1007/s13304-024-01955-8. Epub 2024 Aug 2.
Acute cholecyctitis is a common condition which requires immediate or elective surgical interventions and this condition is one among the common causes for emergency hospitalization among the elderly population. However, controversies have been observed with the use of anti-thrombotic agents in patients undergoing laparoscopic cholecyctectomy. Few studies have reported increased risk of bleeding in patients with anticoagulants whereas other studies have reported no significant bleeding outcomes. Nevertheless, the lack of evidence-based guidelines further complicates decision-making. In this analysis we aimed to systematically assess the impact of anti-thrombotic therapy on bleeding outcomes and thrombosis following laparoscopic cholecystectomy. MEDLINE, EMBASE, Cochrane database, Google scholar, Web of Science and http://www.ClinicalTrials.gov were searched for relevant publications based on anti-thrombotic therapy among patients who underwent laparoscopic cholecystectomy. The endpoints in this analysis included: intra-operative bleeding, post-operative bleeding, blood loss, patients requiring blood transfusion and thrombotic complications. The Revman 5.4 software was used to analyze data in this analysis. Risk ratio (RR) with 95% confidence intervals (CIs) were used to represent the data following analysis. A total number of 4008 participants (enrollment period 2002-2019) were included in this analysis whereby 756 participants were assigned to an anti-thrombotic therapy and 3592 participants were in the control group. Our results showed that antithrombotic therapy was associated with significantly higher risk of intra-operative bleeding (RR: 2.23, 95% CI: 1.77-2.79; P = 0.00001), post-operative bleeding (RR: 4.77, 95% CI: 1.13-20.10; P = 0.03), and blood loss (RR: 3.01, 95% CI: 1.13-8.06; P = 0.03). Patients requiring blood transfusion (RR: 4.80, 95% CI: 1.90-12.13; P = 0.0009) were also significantly higher in the anti-thrombotic group. However, thrombotic complications (RR: 2.17, 95% CI: 0.50-9.42; P = 0.30) were not significantly higher. Through this analysis, we concluded that anti-thrombotic therapy was associated with significantly increased risks of intra-operative and post-operative bleeding events following laparoscopic cholecystectomy. Patients requiring blood transfusion were also significantly higher. Therefore, stopping anti-thrombotic agents prior to laparoscopic cholecystectomy could significantly minimize bleeding risks.
急性胆囊炎是一种常见病症，需要立即或择期进行手术干预，这种病症是老年人急诊住院的常见原因之一。然而，在接受腹腔镜胆囊切除术的患者中使用抗血栓药物存在争议。一些研究报告抗凝剂患者出血风险增加，而其他研究则报告出血结局无显著差异。然而，缺乏循证指南进一步使决策复杂化。在这项分析中，我们旨在系统评估抗血栓治疗对腹腔镜胆囊切除术后出血和血栓形成的影响。根据接受腹腔镜胆囊切除术的患者的抗血栓治疗情况，在 MEDLINE、EMBASE、Cochrane 数据库、Google Scholar、Web of Science 和 http://www.ClinicalTrials.gov 上搜索了相关文献。本分析中的终点包括：术中出血、术后出血、失血、需要输血的患者和血栓并发症。使用 Revman 5.4 软件分析本分析中的数据。使用风险比 (RR) 和 95%置信区间 (CI) 表示分析后的数据。本分析共纳入 4008 名参与者（招募期为 2002-2019 年），其中 756 名参与者接受抗血栓治疗，3592 名参与者为对照组。我们的结果表明，抗血栓治疗与术中出血风险显著增加相关（RR：2.23，95%CI：1.77-2.79；P=0.00001）、术后出血（RR：4.77，95%CI：1.13-20.10；P=0.03）和失血（RR：3.01，95%CI：1.13-8.06；P=0.03）。需要输血的患者（RR：4.80，95%CI：1.90-12.13；P=0.0009）在抗血栓组中也显著更高。然而，血栓并发症（RR：2.17，95%CI：0.50-9.42；P=0.30）没有显著增加。通过这项分析，我们得出结论，抗血栓治疗与腹腔镜胆囊切除术后术中及术后出血事件的风险显著增加相关。需要输血的患者也显著增加。因此，在腹腔镜胆囊切除术前停止抗血栓药物治疗可以显著降低出血风险。
