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Association of Continued Preoperative Aspirin Use and Bleeding Complications in Patients Undergoing Thyroid Surgery

Raggio, Blake S ; Barton, Blair M ; Kandil, Emad ; Friedlander, Paul L

JAMA otolaryngology-- head & neck surgery, 2018-04, Vol.144 (4), p.335-341 [Periódico revisado por pares]

United States: American Medical Association

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  • Título:
    Association of Continued Preoperative Aspirin Use and Bleeding Complications in Patients Undergoing Thyroid Surgery
  • Autor: Raggio, Blake S ; Barton, Blair M ; Kandil, Emad ; Friedlander, Paul L
  • Assuntos: Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aspirin - adverse effects ; Blood Loss, Surgical - statistics & numerical data ; Hematoma - etiology ; Humans ; Middle Aged ; Online First ; Original Investigation ; Platelet Aggregation Inhibitors - adverse effects ; Preoperative Care ; Recurrent Laryngeal Nerve Injuries - etiology ; Retrospective Studies ; Thyroid Diseases - surgery ; Young Adult
  • É parte de: JAMA otolaryngology-- head & neck surgery, 2018-04, Vol.144 (4), p.335-341
  • Descrição: IMPORTANCE: No evidence exists to direct the management of preoperative aspirin (acetylsalicylic acid) use in patients undergoing thyroid surgery. Nevertheless, a considerable number of patients interrupt receiving aspirin therapy during the preoperative period to minimize bleeding complications despite the increased risk of experiencing major adverse cardiac events. OBJECTIVE: To determine whether aspirin therapy continued preoperatively increases bleeding complications in patients undergoing thyroid surgery. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of a consecutive sample of 570 patients, aged 18 to 100 years, who underwent thyroid surgery for benign and malignant disease from January 1, 2010, to December 31, 2015, by a single surgeon at a tertiary referral hospital center in New Orleans, Louisiana. EXPOSURES: Patients receiving aspirin therapy and patients not receiving aspirin therapy (aspirin naive) preoperatively. MAIN OUTCOMES AND MEASURES: Comparison of estimated blood loss, substantial blood loss, operative hematoma, nonoperative hematoma, and recurrent laryngeal nerve injury. RESULTS: Of 570 patients who underwent thyroid surgery, 106 (18.6%) were performed in patients receiving aspirin; of these, 23 (21.7%) were men and 105 (99.1%) were older than 45 years. Those receiving aspirin therapy displayed a 14.4-year difference in age (95% CI, 11.6-17.1). The aspirin group displayed a 20.3% absolute increase (95% CI, 9.3-30.7) in African American patients. Aspirin therapy was not associated with a statistically significant or clinically meaningful increase in intraoperative blood loss (2.5 mL; 95% CI, –0.4 to 5.3). Aspirin therapy was associated with a statistically significant increase in total hematoma formation (3.3%; 95% CI, 0.4-9.0), but the results were inconclusive. Aspirin therapy was not associated with a statistically significant increase in recurrent laryngeal nerve injury (2.6%; 95% CI, –1.1 to 8.6), but the results were inconclusive. CONCLUSIONS AND RELEVANCE: These results suggest that aspirin therapy can be maintained prior to thyroid surgery without increased intraoperative bleeding. Further research with a larger sample size and more outcome events are required to make definitive conclusions regarding the association between aspirin use and complications, including hematoma and recurrent laryngeal nerve injury.
  • Editor: United States: American Medical Association
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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