Tariq Faryal, Ali Hasnain, Baig Abdul Moeed, Kajal Fnu, Raj Rohit, Afzal-Tohid Sumera, Elochukwu Ndubuisi Victoria C, Goit Chandra Shekhar
General Medicine, East Kent Hospitals University NHS Foundation Trust, Margate, GBR.
Trauma and Orthopedics Surgery, Shifa International Hospital, Islamabad, PAK.
Cureus. 2025 Jul 21;17(7):e88473. doi: 10.7759/cureus.88473. eCollection 2025 Jul.
Antithrombotic therapy is commonly prescribed for the prevention and management of thromboembolic diseases but poses significant challenges in the perioperative setting of gastrointestinal (GI) surgery due to the competing risks of bleeding and thrombosis. This meta-analysis aimed to evaluate the clinical outcomes associated with perioperative antithrombotic therapy in patients undergoing GI surgery. A systematic search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, ProQuest, and Google Scholar, following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Nine studies comprising 13,107 patients were included. The primary outcomes assessed were postoperative bleeding, thromboembolic events, and blood transfusion requirements. Statistical analysis was performed using a DerSimonian-Laird random-effects model, and outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). The pooled analysis showed a non-significant trend toward increased postoperative bleeding in patients on antithrombotic therapy (OR: 1.64, 95% CI: 0.98-2.75, p = 0.061). Thromboembolic events did not differ significantly between groups (OR: 0.91, 95% CI: 0.41-2.04, p = 0.82), with low heterogeneity (I² = 0%). However, transfusion requirements were significantly higher in the antithrombotic group (OR: 2.87, 95% CI: 1.19-6.95, p = 0.019), indicating an increased need for intraoperative or postoperative blood products. While continuation of aspirin monotherapy appeared relatively safe in elective settings, dual antiplatelet therapy and direct oral anticoagulants (DOACs) were associated with greater bleeding risks, particularly in complex or minimally invasive procedures. These findings suggest that with careful patient selection and perioperative planning, antithrombotic therapy can often be safely managed during GI surgery. However, individualized risk assessment remains critical to minimize adverse outcomes. Further randomized controlled trials are needed to establish clear guidelines for antithrombotic management in this surgical population.
抗栓治疗常用于预防和管理血栓栓塞性疾病，但在胃肠道（GI）手术的围手术期，由于出血和血栓形成的风险相互竞争，带来了重大挑战。本荟萃分析旨在评估接受GI手术患者围手术期抗栓治疗的临床结局。按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，在PubMed、Cochrane对照试验中心注册库（CENTRAL）、Scopus、ProQuest和谷歌学术上进行了系统检索。纳入了9项研究，共13107例患者。评估的主要结局为术后出血、血栓栓塞事件和输血需求。采用DerSimonian-Laird随机效应模型进行统计分析，结果以比值比（OR）及95%置信区间（CI）报告。汇总分析显示，接受抗栓治疗的患者术后出血有增加的趋势，但无统计学意义（OR：1.64，95%CI：0.98 - 2.75，p = 0.061）。两组间血栓栓塞事件无显著差异（OR：0.91，95%CI：0.41 - 2.04，p = 0.82），异质性较低（I² = 0%）。然而，抗栓治疗组的输血需求显著更高（OR：2.87，95%CI：1.19 - 6.95，p = 0.019），表明术中或术后对血液制品的需求增加。虽然在择期手术中继续使用阿司匹林单药治疗似乎相对安全，但双联抗血小板治疗和直接口服抗凝剂（DOACs）与更高的出血风险相关，尤其是在复杂手术或微创手术中。这些发现表明，通过仔细的患者选择和围手术期规划，抗栓治疗在GI手术期间通常可以安全管理。然而，个体化风险评估对于将不良结局降至最低仍然至关重要。需要进一步的随机对照试验来建立该手术人群抗栓管理的明确指南。
