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Association between preoperative use of antithrombotic medications and intraoperative transfusion in older patients undergoing cancer surgery
a College of Pharmacy & Division of Life Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea b Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 13620, South Korea
c College of Pharmacy, Hanyang University, Ansan, 15588, South Korea
d Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, South Korea
Summary Background: Management of antiplatelet agents and other chronic anticoagula-tion medications in patients scheduled for surgery can reduce intraoperative bleeding compli-cations. However, few studies on the association of antithrombotics, relative to their duration of action, with intraoperative transfusion have been conducted. We aimed to determine the association of recent use of antithrombotics, relative to their duration of action, with intrao-perative transfusion in elderly people undergoing cancer surgery.
Methods: The study subjects were patients aged 65 years or older who were scheduled for can-cer surgery and presented for comprehensive geriatric assessment. We reviewed the baseline patient characteristics obtained from electronic medical records and the patients’ preopera-tive medication history, including anticoagulants, antiplatelet agents, and streptokinase/ streptodornase.
Results: A total of 475 cancer patients were included. Multivariate analysis showed that long-acting anticoagulant therapy before surgery was a significant risk factor for intraoperative transfusion. Long-acting anticoagulants increased the risk of transfusion approximately 15.9-fold (95% CI 1.9e136.2). The attributable risk of long-acting anticoagulants to transfusion
* Corresponding author. College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, 52 Ewhayeodae-
1 The authors equally contributed to gastric pits work.
1015-9584/ª 2019 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article as: Jeong YM et al., Association between preoperative use of antithrombotic medications and intraoperative transfusion in older patients undergoing cancer surgery, Asian Journal of Surgery, https://doi.org/10.1016/j.asjsur.2019.06.005
was approximately 93.7%. Also, low body mass index (BMI) and hepato-pancreato-biliary (HPB) surgery were significantly associated with intraoperative transfusion. The adjusted odds ratios for low BMI (<18.5 kg/m2) and HPB surgery (reference: lower gastrointestinal surgery) were 5.3 (95% CI 1.8e15.4) and 4.9 (95% CI 1.9e12.5), respectively.
Conclusions: It was found that the perioperative use of long-acting anticoagulants was associ-ated with an increased risk of intraoperative transfusion, further highlighting the importance of medication optimization for elderly patients with cancer surgery.
ª 2019 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).