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OBJECTIVES: To compare the clinical benefit of using albumin versus crystalloids for volume resuscitation on organ function in adult patients after liver transplantation. DESIGN: A retrospective cohort study SETTING: Data from a tertiary care facility electronic medical records on liver transplantation patients admitted to the intensive care unit (ICU). PATIENTS: Adults admitted to the ICU after liver transplantation. INTERVENTIONS: Crystalloid fluid resuscitation compared to albumin 5% in the immediate postoperative period after liver transplant. MEASUREMENTS AND MAIN RESULTS: Adults who underwent liver transplant surgery and received a 5% albumin solution were compared with those who received a crystalloid solution. Demographic, etiology, clinical variables, perioperative, and outcome variables were collected. The data were analyzed using the t test, two-way analysis of variance, and multivariate analysis. After applying all the exclusion criteria, the study group comprised 57 adult patients (30 males; 52.6%) who underwent liver transplantation, including 27 patients in the crystalloid group (47.4%) and 30 patients in the albumin group (52.6%). The mean patient age was 52.2 years. Patient characteristics were similar in the 2 groups. Daily Sequential Organ Failure Assessment (SOFA) scores decreased gradually during the postoperative period in both groups, and the trend in SOFA scores was similar in the 2 groups. Analysis showed no statistical difference in SOFA score between the 2 groups postoperatively (P = .84). Multivariate linear regression analysis identified the Model for End-stage Liver Disease (MELD) score as a predictor of the 7-day postoperative SOFA score in this population. CONCLUSIONS: In this study, the use of albumin or crystalloid solution in patients undergoing liver transplantation appeared to have no significant difference in terms of the risk of organ dysfunction. However, further research is needed to confirm these findings and fully understand the potential benefits and risks of using either type of fluid.
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This review highlights noteworthy literature published in 2023 and pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We feature 9 studies from 593 peer-reviewed papers on pancreatic transplantation, 3 from 194 on intestinal transplantation, and 28 from over 4513 on kidney transplantation. The liver transplantation section includes a special focus on 20 studies from 5666 clinical trial publications. We explore a broad range of topics, including donor management, perioperative recipient management, and innovative pharmacologic and mechanical interventions tested for the improvement of patient and graft outcomes and survival.
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Transplante de Rim , Transplante de Fígado , Transplante de Pâncreas , Humanos , Transplante de Fígado/métodos , Transplante de Pâncreas/métodos , Transplante de Rim/métodos , Intestinos/transplante , Sobrevivência de Enxerto , Assistência Perioperatória/métodosRESUMO
Preterm birth (PTB) is the leading cause of neonatal mortality, and reducing the PTB rate is one of the most critical issues in perinatal medicine. Cervical insufficiency (CI), a major cause of PTB, is characterised by premature cervical ripening in the second trimester, followed by recurrent pregnancy loss. Although multiple clinical trials have suggested that progesterone inhibits cervical ripening, no studies have focused on progesterone-induced molecular signalling in CI. Here, we established a primary culture system for human uterine cervical fibroblasts using a sample of patients with refractory innate CI who underwent transabdominal cervical cerclage and patients with low Bishop scores who underwent elective caesarean section as controls. RNA sequencing showed that the progesterone response observed in the control group was impaired in the CI group. This was consistent with the finding that progesterone receptor expression was markedly downregulated in CI. Furthermore, the inhibitory effect of progesterone on lipopolysaccharide-induced inflammatory stimuli was also impaired in CI. These results suggest that abnormal cervical ripening in CI is caused by the downregulation of progesterone signalling at the receptor level, and provide a novel insight into the molecular mechanism of PTB.
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Cerclagem Cervical , Nascimento Prematuro , Humanos , Gravidez , Recém-Nascido , Feminino , Progesterona/farmacologia , Progesterona/uso terapêutico , Nascimento Prematuro/tratamento farmacológico , Cesárea , Cerclagem Cervical/métodos , Colo do ÚteroRESUMO
A 45-year-old man complaining of chest and back pain due to acute aortic dissection was referred to our department. A contrast enhanced computed tomography( CT) scan showed Stanford type B aortic dissection with Kommerell diverticulum and aberrant right subclavian artery. The patient underwent antihypertensive treatment for one month. Despite the successful treatment, CT scan revealed a 5 mm false lumen dilatation in this period. We decided to close the primary entry. The operation was performed through median sternotomy;after establishing cardio-pulmonary bypass, the ostium of the aberrant right subclavian artery( ARSA) was sutured closed and anastomosed the ARSA and right common carotid artery. Total arch replacement was performed using frozen elephant trunk technique. His postoperative course was uneventful.
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Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Anormalidades Cardiovasculares , Masculino , Humanos , Pessoa de Meia-Idade , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Anormalidades Cardiovasculares/complicações , Anormalidades Cardiovasculares/diagnóstico por imagem , Anormalidades Cardiovasculares/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodosRESUMO
Purpose: To evaluate the effects of deep learning reconstruction (DLR) on image quality of abdominal computed tomography (CT) in patients without arm elevation compared with hybrid-iterative reconstruction (Hybrid-IR) and filtered back projection (FBP). Methods: In this retrospective study, axial images of 26 patients who underwent CT without arm elevation were reconstructed using DLR, Hybrid-IR, and FBP. Streak artifact index (SAI) was calculated by dividing the standard deviation of CT attenuation in the liver or spleen by that in fat. Two other blinded radiologists evaluated streak artifacts on images (in the liver, spleen, and kidney), depiction of liver vessels, subjective image noise, and overall quality. They were also asked to detect space-occupying lesions other than cysts in the liver, spleen, and kidney. Results: The SAI (liver/spleen) in DLR images was significantly reduced compared with Hybrid-IR and FBP. Regarding qualitative image analysis, streak artifacts in the 3 organs, qualitative image noise, and overall quality in DLR images were rated by both readers as significantly improved compared with Hybrid-IR (P ≤ .012) and FBP (P < .001). Both blinded readers detected more lesions on DLR images than on Hybrid-IR and FBP ones. Conclusion: DLR resulted in significantly better-quality abdominal CT images in patients scanned without elevating their arms with reducing streak artifacts compared with Hybrid-IR and FBP.
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Braço , Aprendizado Profundo , Humanos , Estudos Retrospectivos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Doses de Radiação , Tomografia Computadorizada por Raios X/métodos , AlgoritmosRESUMO
A displaced left upper bronchus is a rare anomaly. We report the case of a 45-year-old man with a displaced bronchus, branching from the left main bronchus and bifurcating into the apicoposterior and anterior segment bronchi of the left upper lobe. The displaced bronchus passed behind the left pulmonary artery. To our knowledge, 12 similar cases of displaced bronchi have been reported to date. Displaced bronchi are difficult to detect prospectively on computed tomography. However, evaluating the accessory fissures may help establish an accurate diagnosis.
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We treated an 80-year-old Japanese woman who had Takotsubo syndrome (TTS) concomitant with a left atrial (LA) tumor. Left ventriculography revealed a variant of TTS. In cardiac surgery, the LA mass was successfully resected without embolism, with the pathological diagnosis of myxoma.
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Endometrial stromal sarcoma is a rare uterine mesenchymal neoplasm, and extrauterine endometrial stromal sarcoma is even rarer, with a limited number of case reports. In the present report, we present a case of low-grade extrauterine endometrial stromal sarcoma originating from the mesentery in a 49-year-old woman, without endometrial stromal sarcoma in the uterus or evidence of endometriosis. The tumor was diagnosed using recombination of the JAZF1 gene by fluorescence in situ hybridization. Computed tomography, magnetic resonance imaging, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography showed a 13 cm, primarily polycystic, mass containing a contrast-enhancing solid component with restricted diffusion and mild 18F-fluorodeoxyglucose uptake. A large cystic component may be a characteristic feature of extrauterine endometrial stromal sarcoma, given the low pressure from the surrounding tissues.
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An 83-year-old woman with congestive heart failure due to severe mitral regurgitation was referred to our department. Because acute coronary syndrome was suspected, the patient underwent emergent coronary artery angiography, which showed 75% stenosis of segment 2 and 90% stenosis of segment 11. Subsequently, segment 11 was treated by percutaneous coronary intervention. Additionally, transesophageal echocardiography findings showed a prolapse of P2 due to papillary muscle rupture. After management of heart failure, a scheduled operation was performed under the diagnosis of acute mitral regurgitation due to papillary muscle rupture. Intraoperative findings demonstrated a rupture of the anterior papillary muscle, prolapse of P2, and no evidence of infection. The patient underwent mitral valve repair with artificial chordae through median sternotomy. Her postoperative course was uneventful.
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Procedimentos Cirúrgicos Cardíacos , Ruptura Cardíaca Pós-Infarto , Insuficiência da Valva Mitral , Idoso de 80 Anos ou mais , Feminino , Ruptura Cardíaca Pós-Infarto/complicações , Ruptura Cardíaca Pós-Infarto/diagnóstico por imagem , Ruptura Cardíaca Pós-Infarto/cirurgia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/cirurgiaRESUMO
Osteopontin (OPN) is a multifunctional secreted glycoprotein. We evaluated OPN concentrations in blood and follicular fluid (FF) during the ovarian cycle and their relationship with the production of vascular endothelial growth factor (VEGF), which is involved in the pathophysiology of ovarian hyperstimulation syndrome (OHSS). Twenty-two women undergoing in vitro fertilization (minimal stimulation protocol with clomiphene citrate) were enrolled. Samples were collected (a) on the third day of withdrawal bleeding, (b) 2 days before oocyte retrieval, and (c) on the day of oocyte retrieval. FF was collected during oocyte retrieval. The OPN concentration in each specimen and the VEGF concentration in FF was measured by enzyme-linked immunosorbent assays. Plasma OPN concentrations were (in ng/mL): (a) 416 ± 37.2, (b) 378 ± 35.8, and (c) 390 ± 40.0, with no significant differences between the groups. The OPN concentration in FF was 106 ± 13.4 ng/mL. A positive correlation was found between OPN concentrations in FF and plasma samples. A positive correlation was also found between plasma OPN and FF VEGF concentrations, irrespective of the blood-sampling period. Plasma OPN concentration is suggested to reflect the FF VEGF level at oocyte retrieval and maybe a novel clinical marker for predicting the risk for OHSS.
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Líquido Folicular/metabolismo , Ciclo Menstrual/metabolismo , Osteopontina/sangue , Osteopontina/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Adulto , Feminino , Humanos , Síndrome de Hiperestimulação Ovariana/sangue , Síndrome de Hiperestimulação Ovariana/metabolismoRESUMO
Amyotrophic lateral sclerosis/frontotemporal lobar degeneration-linked proteins, TDP-43 and fused in sarcoma (FUS), bind to G-quadruplex-containing mRNAs and transport them to distal neurites for local translation. The specificity and mechanism of G4-RNA binding, however, remain largely unsolved. Using purified full-length TDP-43 and FUS and a set of seven G4-DNA/RNA, we compared their recognition properties of G4-RNAs. Both TDP-43 and FUS recognized and bound to G4-DNA/RNAs, but the target selectivity differed between two proteins. TDP-43 recognized only parallel-stranded G4-DNA/RNAs, leading to stabilize the G4 conformation. In contrast, FUS bound to all three types, parallel, hybrid, and antiparallel, of G4-DNA/RNAs, resulting in deformation of the G4 structure. We then concluded that the target selectivity and the influence on G4 RNA structure differed between TDP-43 and FUS.
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Proteínas de Ligação a DNA/química , DNA/química , Quadruplex G , RNA Mensageiro/química , Proteína FUS de Ligação a RNA/química , Esclerose Lateral Amiotrófica/genética , Esclerose Lateral Amiotrófica/metabolismo , Esclerose Lateral Amiotrófica/patologia , Sequência de Bases , Sítios de Ligação , Clonagem Molecular , DNA/genética , DNA/metabolismo , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo , Escherichia coli/genética , Escherichia coli/metabolismo , Degeneração Lobar Frontotemporal/genética , Degeneração Lobar Frontotemporal/metabolismo , Degeneração Lobar Frontotemporal/patologia , Expressão Gênica , Vetores Genéticos/química , Vetores Genéticos/metabolismo , Células HEK293 , Humanos , Neurônios/metabolismo , Neurônios/patologia , Conformação de Ácido Nucleico , Ligação Proteica , Conformação Proteica , Domínios e Motivos de Interação entre Proteínas , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Proteína FUS de Ligação a RNA/genética , Proteína FUS de Ligação a RNA/metabolismo , Proteínas Recombinantes/química , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismoRESUMO
BACKGROUND: Clinically applied as anti-gout drugs, xanthine oxidoreductase (XOR) inhibitors, especially the potent, selective, non-purine-analog XOR inhibitors febuxostat and topiroxostat, exert organ-protective effects. We tested the hypothesis that preservation of tissue concentrations of high-energy phosphates, such as ATP and ADP, contributes to organ-protective effects through CE-TOFMS metabolomics. METHODS: Rats were subjected to 30 min of renal ischemia-reperfusion (I/R) injury 60 min after oral administration of 10 mg/kg febuxostat, 10 mg/kg topiroxostat, 50 mg/kg allopurinol, or vehicle. RESULTS: In non-purine-analog XOR inhibitor-treated groups, renal concentrations of high-energy phosphates were greater before and after I/R injury, and renal adenine compounds were less depleted by I/R injury than in the vehicle and allopurinol groups. These findings were well in accordance with the proposed hypothesis that the recomposition of high-energy phosphates is promoted by non-purine-analog XOR inhibitors via the salvage pathway through blockade of hypoxanthine catabolism, whereas non-specific inhibitory effects of allopurinol on purine/pyrimidine enzymes impede this re-synthesis process. CONCLUSIONS: This metabolic approach shed light on the physiology of the organ-protective effects of XOR inhibitors.
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Inibidores Enzimáticos/farmacologia , Metaboloma , Purinas/metabolismo , Pirimidinas/metabolismo , Traumatismo por Reperfusão/metabolismo , Xantina Desidrogenase/antagonistas & inibidores , Animais , Modelos Animais de Doenças , Masculino , Metaboloma/efeitos dos fármacos , Metaboloma/fisiologia , Metabolômica , Ratos , Ratos Sprague-Dawley , Xantina Desidrogenase/metabolismoRESUMO
Reported here is the N2 cleavage of a one-electron oxidation reaction using trans-[Mo(depe)2 (N2 )2 ] (1) (depe=Et2 PCH2 CH2 PEt2 ), which is a classical molybdenum(0)-dinitrogen complex supported by two bidentate phosphine ligands. The molybdenum(IV) terminal nitride complex [Mo(depe)2 N][BArf4 ] (2) (BArf4 =B(3,5-(CF3 )2 C6 H3 )4 ) is synthesized by the one-electron oxidation of 1 upon addition of a mild oxidant, [Cp2 Fe][BArf4 ] (Cp=C5 H5 ), and proceeds by N2 cleavage from a MoII -N=N-MoII structure. In addition, the electrochemical oxidation reaction for 1 also cleaved the N2 ligand to give 2. The dimeric Mo complex with a bridging N2 is detected by in situ resonance Raman and in situ UV-vis spectroscopies during the electrochemical oxidation reaction for 1. Density-functional theory (DFT) calculations reveal that the unstable monomeric oxidized MoI species is converted into 2 via the dimeric structure involving a zigzag transition state.
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Dinitrogen-divanadium complexes with triamidoamine ligands, 1-3, were synthesized and characterized by resonance Raman, UV-vis, and NMR spectroscopy and elemental and X-ray structure analyses. X-ray structure analyses reveal that all three of the complexes have a dimeric structure with a µ-N2 ligand (N-N bond length 1.200-1.221 Å). Resonance Raman and NMR spectra of 1-3 in solution show that these complexes maintain a dimeric structure in benzene and toluene solutions. 15N NMR spectra of 1 and 3 have peaks assignable to µ-N2 ligands at 33.4 and 27.6 ppm, respectively, but 2 does not have a similar peak under the same conditions. In 51V NMR spectra, the peaks of vanadium ions were observed at -173.3, -143.8, and -240.2 ppm, respectively, which are in a higher magnetic field region in comparison to those of dinitrogen-divanadium complexes reported previously. The structure and electronic properties of 1 are supported by DFT calculations. Additionally, all complexes react with excess amounts of M[C10H8] (M = Na, K) and the proton sources HOTf, HCl, and [LutH]OTf (Lut = 2,6-dimethylpyridine) to produce ammonia without hydrazine. The ammonia produced was evaluated as an ammonium salt by 1H and 15N NMR spectroscopy. The yield of NH3 produced in the reaction of 1 with Na[C10H8] and HOTf under N2 was 151% (per V atom).
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Immunoproteomic analysis was performed to identify unknown, pathology-related molecules in patients with seronegative (SN) obstetric antiphospholipid syndrome (APS) who clinically satisfied the diagnostic criteria for APS, but not the serological criteria. We collected peripheral blood from 13 SN-APS outpatients with known thrombotic predisposition, 13 with no known thrombotic predisposition, and four multiparous women with no history of miscarriage (control). Plasma proteins from volunteers were purified and used as plasma protein antigens. Two-dimensional immunoblotting was performed using pooled control or SN-APS serum samples as the primary antibodies. Mass spectrometry of reactive spots specific to SN-APS serum led to the identification of complement molecule C9. Western blotting using commercial purified alkylated C9 was performed to detect autoantibodies. Examination of individual patient serum identified reactivity in one patient with, and in two patients without known thrombotic predisposition. This study suggests that SN-APS pathologies were associated with autoantibodies that react to specific C9 epitopes.
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Síndrome Antifosfolipídica/imunologia , Autoanticorpos/sangue , Complemento C9/imunologia , Proteômica/métodos , Adulto , Síndrome Antifosfolipídica/sangue , Biomarcadores/sangue , Eletroforese em Gel Bidimensional , Epitopos/imunologia , Feminino , Humanos , Masculino , Espectrometria de MassasRESUMO
BACKGROUND: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) has recently been utilized to accurately detect the amyloid proteins of renal amyloidosis. The present study investigated the optimal procedures for analyzing samples by LCMS/MS, and the advantage of using this technique to diagnosis renal amyloidosis. METHODS: To detect amyloid proteins, laser microdissected glomeruli from AL (n = 13) or AA (n = 10) renal amyloidosis patients were digested and analyzed by LCMS/MS. To determine the best procedures for analyzing samples by LCMS/MS, we examined the suitability of tissue samples, frozen or formalin-fixed paraffin-embedded (FFPE), the number of dissected glomeruli required for analysis (2, 10, or 50 glomeruli), and the amount of trypsin with or without dithiothreitol (DTT). We additionally compared the detection of amyloid proteins between immunostaining and LCMS/MS. RESULTS: Examining 10 dissected glomeruli from FFPE sections digested with trypsin 3 µL (0.1 mg/mL) without DDT made it possible to detect amyloid protein in all 10 AA and in 10 out of 12 AL amyloidosis cases. All AA amyloidosis cases were diagnosed using immunohistochemistry for amyloid A. With immunostaining, however, there were several inconclusive immunoglobulin and/or their light chain staining noted in the AA or AL amyloidosis cases. Even so, LCMS/MS was able to accurately detect amyloid protein in renal amyloidosis. CONCLUSION: The use of 10 laser microdissected glomeruli (170,000-220,000 µm2) with amyloid deposition from FFPE sections digested with trypsin 3 µL (0.1 mg/mL) allowed the accurate detection of amyloid protein in AA and AL amyloidosis.
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Amiloidose/diagnóstico , Cromatografia Líquida , Nefropatias/diagnóstico , Espectrometria de Massas em Tandem , Animais , Humanos , Japão , Glomérulos Renais/patologia , Camundongos , Microdissecção , CoelhosRESUMO
PROBLEM: The effectiveness of progesterone (P4) treatment for preventing preterm births is unclear. Its effects on the uterine cervix were tested using cultured human uterine cervical fibroblasts (UCFs). METHOD OF STUDY: UCFs were incubated with lipopolysaccharide (LPS) in the presence or absence of P4 under various conditions. mRNA was subjected to PCR arrays and real-time RT-PCR to assess IL-6, IL-8, IL-1beta, PTGS2, MMP-1, and CXCL10 expression. RESULTS: When exposed to a high-LPS concentration (2.0 µg/mL), expression of these genes was not suppressed by simultaneous P4 (1.0 µmol/L) treatment, but it was significantly inhibited when P4 was administered 1 hour prior to LPS, with the exception of the chemokines IL-8 and CXCL10. Expression of all genes was restricted by P4 under low-level LPS (0.2 µg/mL) stimulation, especially when administered prior to LPS treatment. CONCLUSION: These data suggest that early or prophylactic P4 administration is an effective and important measure for reducing preterm birth risk.
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Colo do Útero/patologia , Fibroblastos/fisiologia , Inflamação/tratamento farmacológico , Nascimento Prematuro/tratamento farmacológico , Progesterona/farmacologia , Células Cultivadas , Ciclo-Oxigenase 2/genética , Ciclo-Oxigenase 2/metabolismo , Citocinas/metabolismo , Feminino , Humanos , Inflamação/imunologia , Lipopolissacarídeos/imunologia , Metaloproteinase 1 da Matriz/genética , Metaloproteinase 1 da Matriz/metabolismo , Gravidez , Nascimento Prematuro/imunologia , RNA Mensageiro/análiseRESUMO
Coordination of N2 to [(Cp2TiCl)2] in a non-coordinating ionic liquid, Pyr4FAP, was studied by UV-vis/NIR and EPR spectroscopies. [(Cp2TiCl)2] is in equilibrium between monomeric [Cp2TiCl] and dimeric species [(Cp2TiCl)2]. The frozen solution EPR spectrum revealed the coordination of N2 to [Cp2TiCl], suggesting that Pyr4FAP promotes N2 coordination to the Ti(iii) center.
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Recent publications provided controversial results indicating that perioperative heparin bridging anticoagulation (HBA) increased the bleeding risk without decreasing the thromboembolic risk in patients undergoing minor surgery. To investigate if this is also the case in high-risk patients undergoing major abdominal malignancy surgery, we retrospectively collected data of 3268 patients over a 10-year period. After the interruption of preoperative antithrombotic agents, HBA was initiated with a prophylactic-dose of unfractionated heparin in 133 patients (HBA group), and 62 patients did not receive HBA (non-HBA group). The incidence of exogenous blood transfusion (EBT) and thromboembolic events (TEEs) within 30 days after surgery were compared between the HBA and non-HBA groups. The results showed that the incidence of EBT and TEEs was similar between the two groups (23.3 vs 19.4 %; P = 0.535) and (4.1 vs 3.2 %; P = 0.821), respectively. The amount of intraoperative bleeding and the length of postoperative hospital stay were also similar [median (quantile 1-3); 192 (71-498) vs 228 ml (100-685); P = 0.422] and [12 (9-19) vs 14.5 days (10-21); P = 0.052], respectively. These findings may suggest it is unlikely that prophylactic-dose HBA affects bleeding and thromboembolic risks in patients undergoing major abdominal malignancy surgery.
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Anticoagulantes/administração & dosagem , Hemorragia/epidemiologia , Heparina/administração & dosagem , Neoplasias/cirurgia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Transfusão de Sangue , Feminino , Heparina/efeitos adversos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Risco , Tromboembolia/prevenção & controleRESUMO
BACKGROUND: Controversies still exist whether to continue or withdraw aspirin (ASA) perioperatively. This study was performed to determine whether patients on preoperative antiplatelet therapy (APT) benefit from continuing ASA in terms of thrombotic and bleeding risk prevention. METHODS: Among 307 consecutive patients who were on APT preoperatively for the secondary prevention of cardiovascular disease and who underwent elective major abdominal malignancy surgery, 148 patients had all the preoperative APT withdrawn and the remaining 159 patients continued only ASA. Comparisons were made between the 2 groups regarding the rate and the amount of exogenous blood transfusion as well as the incidence of thromboembolic events (TEEs) within 1 month after surgery. RESULTS: The incidence of perioperative TEEs of the APT withdrawn group was significantly higher than that of the ASA group (6.2% vs 0%, P = 0.005), while the rate and the amount of exogenous blood transfusion were not different each other (23.6% vs 17.0%, P = 0.146 and 4 units vs 4 units, P = 0.544, respectively). CONCLUSIONS: Considering the relatively low bleeding risk when continued and the increased thrombotic risk after withdrawal, ASA should be continued perioperatively in patients undergoing major abdominal malignancy surgery.