[CURRENT STATUS OF PERIOPERATIVE MANAGEMENT IN PATIENTS UNDERGOING ANTITHROMBOTIC (ANTIPLATELET OR ANTICOAGULATION) THERAPY: RESULTS OF A QUESTIONNAIRE SURVEY].

ABSTRACT

In non-cardiac surgery patients receiving antithrombotic therapy (antiplatelet therapy (APT) and anticoagulation therapy (ACT)) for prevention of cardiovascular and/or cerebrovascular complications, perioperative antithrombotic management is challenging due to increased risks of both bleeding and thromboembolic complications. The effect of APT and/or ACT on surgical outcomes in patients undergoing general or gastroenterologic surgery is still unknown because of the limited evidence. We conducted a survey of 38 major surgical facilities at Kyoto University Related Hospital Surgical Group of Cancer Research on perioperative management in patients undergoing antithrombotic therapy. In elective surgery, most facilities used heparin substitution during cessation of ACT or APT, while surgery was performed under continuation of APT in 22% of facilities. In emergent surgery, the effect of ACT was reversed before surgery, but surgery was performed without the reversal of APT effect. Laparoscopic surgery was performed in most facilities in spite of the use of ACT or APT. Severe bleeding complications requiring transfusion of fresh frozen plasma or platelet were experienced in over half of facilities. Conclusion: Variation of antithrombotic management has shown to be large between facilities. For safe surgical treatment, creation of the perioperative antithrombotic management guideline on the basis of the evidence from multicenter study is requisite.