TY - JOUR
T1 - Association between preoperative use of antithrombotic medications and intraoperative transfusion in older patients undergoing cancer surgery
AU - Jeong, Young Mi
AU - Chung, Jee Eun
AU - Choi, Kyung Suk
AU - Jeon, Min Sun
AU - Yee, Jeong
AU - Lee, Eunsook
AU - Kim, Kwang Il
AU - Lee, Byung Koo
AU - Gwak, Hye Sun
N1 - Publisher Copyright:
© 2019
PY - 2020/5
Y1 - 2020/5
N2 - Background: Management of antiplatelet agents and other chronic anticoagulation medications in patients scheduled for surgery can reduce intraoperative bleeding complications. 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 intraoperative transfusion in elderly people undergoing cancer surgery. Methods: The study subjects were patients aged 65 years or older who were scheduled for cancer surgery and presented for comprehensive geriatric assessment. We reviewed the baseline patient characteristics obtained from electronic medical records and the patients' preoperative 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 1.9–136.2). The attributable risk of long-acting anticoagulants to transfusion 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 1.8–15.4) and 4.9 (95% CI 1.9–12.5), respectively. Conclusions: It was found that the perioperative use of long-acting anticoagulants was associated with an increased risk of intraoperative transfusion, further highlighting the importance of medication optimization for elderly patients with cancer surgery.
AB - Background: Management of antiplatelet agents and other chronic anticoagulation medications in patients scheduled for surgery can reduce intraoperative bleeding complications. 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 intraoperative transfusion in elderly people undergoing cancer surgery. Methods: The study subjects were patients aged 65 years or older who were scheduled for cancer surgery and presented for comprehensive geriatric assessment. We reviewed the baseline patient characteristics obtained from electronic medical records and the patients' preoperative 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 1.9–136.2). The attributable risk of long-acting anticoagulants to transfusion 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 1.8–15.4) and 4.9 (95% CI 1.9–12.5), respectively. Conclusions: It was found that the perioperative use of long-acting anticoagulants was associated with an increased risk of intraoperative transfusion, further highlighting the importance of medication optimization for elderly patients with cancer surgery.
KW - Antithrombotics
KW - Comprehensive geriatric assessment
KW - Intraoperative transfusion
KW - Long-acting anticoagulants
KW - Surgical oncology patients
UR - http://www.scopus.com/inward/record.url?scp=85067648924&partnerID=8YFLogxK
U2 - 10.1016/j.asjsur.2019.06.005
DO - 10.1016/j.asjsur.2019.06.005
M3 - Article
C2 - 31253383
AN - SCOPUS:85067648924
SN - 1015-9584
VL - 43
SP - 585
EP - 592
JO - Asian Journal of Surgery
JF - Asian Journal of Surgery
IS - 5
ER -