Objectives: To evaluate the impact of anti-platelet therapy (APT) on surgical outcome of patients requiring emergency surgery while being on APT and of patients assigned for elective surgery and had stopped their APT for one week prior to surgery.
Patients & methods: This selective study included 30 patients on aspirin alone (ASP group), 30 patients on clopidogrel alone (CLO group) and 30 patients receiving both (Combination group); 30 patients without any history of APT (Control group) and 30 patients on combined APT and assigned to elective major surgeries discontinued on their APT for 7 days before surgery. All patients underwent preoperative assessment; preoperative ,intraoperative and postoperative Hb concentration and platelet count,operative time, intraoperative complication, intraoperative and postoperative blood loss, and transfusion requirement were recorded. Length of hospital stay, need for ICU admission and length of ICU stay were recorded. mortality, and 30-day readmission were recorded.
Results: The study included 150 patients with mean age of 59.6±7.3; range: 43-78 years. All patients had co-morbidities in varied combination. Patients received APT showed significantly greater amount of blood loss during and at 12-hr after surgery with concomitantly significant higher number of blood units consumed compared to control group. Patients of CLO group showed the least deviation from elective group. Combination group showed significantly greater blood loss and higher need for blood transfusion compared both to CLO and elective groups. Patients of ASP group showed significantly higher blood loss and more need for transfusion therapy compared to elective group. All patients showed significant intra and postoperative decrease of hemoglobin concentration compared to preoperative concentration, while platelet count showed non-significant difference. Seven patients required admission to ICU; 3 patients of elective, one of control group and 3 patients of APT groups. No mortality was reported during a mean ICU stay of 2.6±1; range: 1-4 days. Mean total postoperative hospital stay was 18.5±5.1; range: 9-31 days.NO 30-day readmission were recorded.
Conclusion: Elective surgery stoppage of APT for 7 day, if not hazardous, is advisable. Emergency surgical procedure for patients maintained on chronic APT is not so harmful despite the increased need for transfusions, but outcome is best for those receiving clopidogrel alone.
Keywords: Anti-platelet therapy, continue, stop, elective surgery, emergency surgery