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Aspirin regimen safe following pancreatic surgery
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Patients who continued aspirin therapy after elective pancreatic surgery were not at increased risk for perioperative bleeding, blood transfusion or surgery-related complications in a recent study.
Researchers evaluated the medical records of 1,017 patients who received either pancreaticoduodenectomy or distal or total pancreatectomy between October 2005 and February 2012 at Thomas Jefferson University Hospital in Philadelphia. Patients on a daily aspirin regimen were advised to continue their regimen through the day of their procedure.
The cohort included 289 patients on an aspirin regimen, predominantly at a daily dose of 81 mg. Users and nonusers had similar estimated intraoperative blood loss (median 400 mL for both groups; P=.661), need for blood transfusion during index admission (29% of users vs. 26% of nonusers; P=.37), median length of hospital stay after surgery (median 7 days vs. 6 days,;P=.103) readmission rates (16.9% vs. 15%; P=.451) and mortality at 30 days (2.4% vs. 0.9%; P=.071).
Complications occurred at similar rates (47% of users vs. 41.9% of nonusers; P=.141), with pancreatic fistula the most common (15.1% of users vs. 13.5% of nonusers; P=.49). Other complications included delayed gastric emptying (10.2% vs. 8.8%; P=.502) and urinary tract infection (8.8% vs. 9.1%; P=.881).
Cardiovascular complications occurred numerically but not significantly more frequently among aspirin users (10.1% of users vs. 7% of nonusers; P=.107), which researchers attributed to an increased number of cardiovascular-related morbidities that may have led to aspirin prescriptions. Of all specific cardiovascular events assessed, including arrhythmia, sudden cardiac death, thrombotic/embolic events, new onset heart block and myocardial infarction (MI), only MI (1.7% vs. 0.4%; P=.032) and MI requiring percutaneous intervention (0.7% vs. 0%; P=.025) occurred more frequently among aspirin users.
“This is the first study to report that aspirin therapy is not associated with increased rates of perioperative bleeding, transfusion requirement or major procedure-related complications after elective pancreatic surgery,” the researchers wrote. “These data suggest that continuation of aspirin is safe and … should be considered acceptable and preferable, particularly in patients with perceived substantial medical need for treatment with antiplatelet therapy.”
Disclosure: The researchers report no relevant financial disclosures.
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