Matsuoka Taisuke, Fujikawa Takahisa, Kawamura Yuichiro, Hasegawa Suguru
Surgery, Kokura Memorial Hospital, Kitakyushu, JPN.
Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, JPN.
Cureus. 2024 Jul 24;16(7):e65303. doi: 10.7759/cureus.65303. eCollection 2024 Jul.
Background The question of whether antiplatelet therapy (APT) should be discontinued prior to gastrectomy is controversial. In this study, we investigated the impact of continuing aspirin preoperatively on perioperative bleeding and thromboembolic complications in patients receiving gastrectomy for malignancy. Methods The study cohort comprised 1001 patients with malignant gastric tumors who had undergone gastrectomy between 2005 and 2021. This study excludes emergency surgery. The patients were allocated to the following three groups: those who continued aspirin monotherapy prior to surgery (cAPT group), those who stopped receiving it seven days prior to surgery (dAPT group), and those who did not take APT at any stage (non-APT group). The differences between the groups in intraoperative and postoperative complications, such as bleeding and thromboembolism, were examined. Results The non-APT group comprised 682 patients, the dAPT group had 164, and the cAPT group had 155. There were 22 bleeding events (2.2%) in the whole cohort, 11 (1.1%) of which occurred in the non-APT group, six (3.7%) in the dAPT group, and five (3.2%) in the cAPT group. The differences between the three groups were not significant in terms of bleeding complications. There were 10 (1.0%) thromboembolic events in the whole cohort, five (0.7%) of which occurred in the non-APT group, four (2.4%) in the dAPT group, and one (0.6%) in the cAPT group. The differences between the three groups were not significant in terms of thromboembolic complications. In a multivariate analysis of the whole cohort, intraoperative blood loss (≥1000 mL) (p < 0.001, odds ratio (OR) = 11.8) and multidrug APT (p < 0.001, OR = 7.8) were both independent predictors of bleeding complications. However, continuing to take aspirin before surgery was not a risk factor for bleeding complications. Conclusions In patients with malignant gastric tumors, preoperative continuation of aspirin monotherapy has no impact on either intraoperative or postoperative bleeding. Gastrectomy can be performed safely, even in patients who continue aspirin treatment.
在胃切除术之前是否应停用抗血小板治疗（APT）这一问题存在争议。在本研究中，我们调查了术前继续使用阿司匹林对接受恶性肿瘤胃切除术患者围手术期出血和血栓栓塞并发症的影响。
研究队列包括2005年至2021年间接受胃切除术的1001例恶性胃肿瘤患者。本研究排除急诊手术。患者被分为以下三组：术前继续使用阿司匹林单药治疗的患者（cAPT组）、术前七天停止使用阿司匹林的患者（dAPT组）以及在任何阶段均未接受APT治疗的患者（非APT组）。检查了三组患者在术中及术后并发症（如出血和血栓栓塞）方面的差异。
非APT组有682例患者，dAPT组有164例，cAPT组有155例。整个队列中有22例出血事件（2.2%），其中11例（1.1%）发生在非APT组；6例（3.7%）发生在dAPT组；5例（3.2%）发生在cAPT组。三组在出血并发症方面的差异无统计学意义。整个队列中有10例（1.0%）血栓栓塞事件，其中5例（0.7%）发生在非APT组；4例（2.4%）发生在dAPT组；1例（0.6%）发生在cAPT组。三组在血栓栓塞并发症方面的差异无统计学意义。在对整个队列的多因素分析中，术中失血量（≥1000 mL）（p < 0.001，比值比（OR） = 11.8）和多种药物联合的APT治疗（p < 0.001，OR = 7.8）均为出血并发症的独立预测因素。然而，术前继续服用阿司匹林并非出血并发症的危险因素。
对于恶性胃肿瘤患者，术前继续使用阿司匹林单药治疗对术中及术后出血均无影响。即使是继续使用阿司匹林治疗的患者，也可安全地进行胃切除术。
