Canu Gian Luigi, Medas Fabio, Cappellacci Federico, Lanzolla Giulia, Rossi Leonardo, Pennestrì Francesco, Di Filippo Giacomo, Chorti Angeliki, Gallucci Pierpaolo, De Palma Andrea, Ambrosini Carlo Enrico, Pliakos Ioannis, Moysidis Moysis, Luzuy-Guarnero Valentine, Bédat Benoit, Salvi Giulia, Tempera Serena Elisa, Carnassale Giulia, Mattia Amelia, Lazzari Giovanni, Guagni Tommaso, Izzo Martina, Boi Francesco, Morelli Eleonora, Feroci Francesco, Traini Emanuela, Princi Pietro, Demarchi Marco Stefano, Papavramidis Theodosios, Raffaelli Marco, Materazzi Gabriele, De Crea Carmela, Calò Pietro Giorgio
Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, Italy.
Endocrinology Unit, Department of Medical Sciences, University of Cagliari, 09042 Monserrato, Italy.
J Clin Med. 2025 May 14;14(10):3435. doi: 10.3390/jcm14103435.
Postoperative neck hematoma is an infrequent but potentially fatal complication following thyroidectomy. The main aim of this study was to evaluate the impact of direct oral anticoagulants (DOACs) on the occurrence of this complication. Patients who underwent thyroidectomy between January 2020 and December 2022 in nine high-volume thyroid surgery centers in Europe were retrospectively evaluated. Based on taking direct oral anticoagulants, patients were divided into two groups: the DOAC Group and the Control Group. Propensity score matching 1:1 was performed between the two groups, which were then compared through a univariate analysis. The total number of patients enrolled based on the inclusion/exclusion criteria was 8985. Following propensity score matching, the study population consisted of 316 patients: 158 in the DOAC Group and 158 in the Control Group. In the DOAC Group, the overall incidence of neck hematoma was 5.70% (4.43% for neck hematomas managed conservatively, and 1.27% for those that required surgical revision of hemostasis). No statistically significant difference was found between the two groups in terms of the incidence of this complication. Hospital readmission due to neck hematoma was not observed in any patient. No statistically significant difference was found between the two groups in terms of the timing of the onset of neck hematomas that required surgical revision of hemostasis. This study showed that direct oral anticoagulants, in the field of thyroid surgery, have no impact on the occurrence of postoperative neck hematoma. Therefore, based on our findings, it can be concluded that thyroidectomy can be safely performed in patients taking this class of drugs.
术后颈部血肿是甲状腺切除术后一种不常见但可能致命的并发症。本研究的主要目的是评估直接口服抗凝剂（DOACs）对该并发症发生情况的影响。对2020年1月至2022年12月期间在欧洲9家高容量甲状腺手术中心接受甲状腺切除术的患者进行了回顾性评估。根据是否服用直接口服抗凝剂，将患者分为两组：DOAC组和对照组。两组之间进行1:1倾向评分匹配,然后通过单因素分析进行比较。根据纳入/排除标准纳入的患者总数为8985例。经过倾向评分匹配后，研究人群包括316例患者：DOAC组158例，对照组158例。在DOAC组中，颈部血肿的总体发生率为5.70%（保守治疗的颈部血肿发生率为4.43%，需要手术止血修正的发生率为1.27%）。两组在该并发症的发生率方面未发现统计学上的显著差异。未观察到任何患者因颈部血肿再次入院。两组在需要手术止血修正的颈部血肿发作时间方面未发现统计学上的显著差异。本研究表明，在甲状腺手术领域，直接口服抗凝剂对术后颈部血肿的发生没有影响。因此，根据我们的研究结果，可以得出结论，服用这类药物的患者可以安全地进行甲状腺切除术。
