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Continuation of antithrombotic therapy increases minor bleeding but does not increase the risk other morbidities in open inguinal hernia repair: A propensity score-matched analysis

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Abstract

Purpose

An aging population has led to an increased number of patients with cardiovascular comorbidities requiring antithrombotic therapy. Perioperatively, surgeons should consider the increased risk of bleeding and thrombotic events in patients continuing or discontinuing these medications. We aimed to analyze the safety of continued antithrombotic therapy during open inguinal hernia repair.

Methods

In this single-center, retrospective study, 4870 adult patients who underwent open inguinal hernia repair surgery by the same surgeon from 2008 January to 2019 March were included. Patients who underwent surgery while continuing antithrombotic therapy were included in the antithrombin group (n = 523) while those who were not under any antithrombotic therapy during the surgery were included in the control group (n = 4333). Using propensity score-matching, we then selected patients from each group with similar backgrounds. Surgery time, anesthesia time, postoperative bleeding, reoperation, and thrombotic event data were compared between the groups. Subgroup analysis based on the type of medications used was performed within the antithrombin group.

Results

Ten patients in the antithrombin group and seven patients in the control group experienced postoperative bleeding (p < 0.001). The rate of postoperative bleeding was the highest in patients taking multiple medications. However, most were managed conservatively. Three patients from the antithrombin group experienced thrombotic events postoperatively (p = 0.001).

Conclusions

Patients receiving continued antithrombotic therapy had an increased risk of minor postoperative bleeding; however, they are a high-risk group for thrombotic events.

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Acknowledgements

Dr. Kyosuke Miyazaki is an advisor to BARD.

Funding

None.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    S. Poudel & S. Hirano

  2. Department of Surgery, Steel Memorial Muroran Hospital, Muroran, Japan

    S. Poudel

  3. Miyazaki Surgery and Hernia Clinic, Kita 5 Nishi 2, Chuo-ku, Sapporo, Japan

    K. Miyazaki

Authors
  1. S. Poudel
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  2. K. Miyazaki
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  3. S. Hirano
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Corresponding author

Correspondence to K. Miyazaki.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This retrospective study was approved by the institutional review board of Hokkaido University (Med 18-037). The notice for this retrospective study was published on the website of the institute and the patients were given the right to opt out.

Human and animal rights

Animals were not used in this study.

Informed consent

Prior to surgery, the risk of both continuation or cessation of antithrombotic medications was explained to all the patients.

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Poudel, S., Miyazaki, K. & Hirano, S. Continuation of antithrombotic therapy increases minor bleeding but does not increase the risk other morbidities in open inguinal hernia repair: A propensity score-matched analysis. Hernia 24, 857–865 (2020). https://doi.org/10.1007/s10029-020-02169-8

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  • DOI: https://doi.org/10.1007/s10029-020-02169-8

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