Impact of antithrombotic therapy on postpancreatectomy hemorrhage in 7116 patients: A project study by the Japanese Society of Hepato-Biliary-Pancreatic Surgery
Kota Nakamura
Department of Surgery, Nara Medical University, Nara, Japan
Search for more papers by this authorMinako Nagai
Department of Surgery, Nara Medical University, Nara, Japan
Search for more papers by this authorIppei Matsumoto
Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
Search for more papers by this authorSohei Satoi
Department of Surgery, Kansai Medical University, Osaka, Japan
Search for more papers by this authorFuyuhiko Motoi
Department of Surgery, Yamagata University Graduate School of Medical Science, Yamagata, Japan
Search for more papers by this authorManabu Kawai
Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
Search for more papers by this authorYasuo Hosouchi
Department of Surgery, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan
Search for more papers by this authorRyota Higuchi
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
Search for more papers by this authorShugo Mizuno
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan
Search for more papers by this authorTakao Ohtsuka
Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
Search for more papers by this authorKeiichi Akahoshi
Department of Hepatobiliary-Pancreatic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
Search for more papers by this authorKenichi Hakamada
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
Search for more papers by this authorMichiaki Unno
Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
Search for more papers by this authorHiroki Yamaue
Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
Search for more papers by this authorMasafumi Nakamura
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Project Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
Search for more papers by this authorItaru Endo
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
Search for more papers by this authorCorresponding Author
Masayuki Sho
Department of Surgery, Nara Medical University, Nara, Japan
Correspondence
Masayuki Sho, Department of Surgery, Nara Medical University, Shijo-cho, Kashihara, Nara 634-8522, Japan.
Email: [email protected]
Search for more papers by this authorKota Nakamura
Department of Surgery, Nara Medical University, Nara, Japan
Search for more papers by this authorMinako Nagai
Department of Surgery, Nara Medical University, Nara, Japan
Search for more papers by this authorIppei Matsumoto
Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
Search for more papers by this authorSohei Satoi
Department of Surgery, Kansai Medical University, Osaka, Japan
Search for more papers by this authorFuyuhiko Motoi
Department of Surgery, Yamagata University Graduate School of Medical Science, Yamagata, Japan
Search for more papers by this authorManabu Kawai
Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
Search for more papers by this authorYasuo Hosouchi
Department of Surgery, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan
Search for more papers by this authorRyota Higuchi
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
Search for more papers by this authorShugo Mizuno
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan
Search for more papers by this authorTakao Ohtsuka
Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
Search for more papers by this authorKeiichi Akahoshi
Department of Hepatobiliary-Pancreatic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
Search for more papers by this authorKenichi Hakamada
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
Search for more papers by this authorMichiaki Unno
Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
Search for more papers by this authorHiroki Yamaue
Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
Search for more papers by this authorMasafumi Nakamura
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Project Committee, Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
Search for more papers by this authorItaru Endo
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
Search for more papers by this authorCorresponding Author
Masayuki Sho
Department of Surgery, Nara Medical University, Nara, Japan
Correspondence
Masayuki Sho, Department of Surgery, Nara Medical University, Shijo-cho, Kashihara, Nara 634-8522, Japan.
Email: [email protected]
Search for more papers by this authorAbstract
Background
We previously reported an association between antithrombotic therapy and an increased risk of postpancreatectomy hemorrhage (PPH). To validate our findings, we conducted a large-scale multicenter retrospective study from 63 high-volume centers in Japan.
Methods
Between 2015 and 2018, 7116 patients who underwent pancreatectomy were enrolled. The antithrombotic group consisted of 920 patients (12.9%) who received preoperative antithrombotic agents including aspirin, clopidogrel, ticlopidine, prasugrel, warfarin, and direct oral anticoagulants.
Results
PPH occurred in 235 (3.3%) of the patients. The incidence of PPH and mortality were significantly higher in the antithrombotic group than in the control group (5.7 vs. 3.0% and 2.2 vs. 0.9%, respectively; both p < .001). In multivariate analysis, a history of antithrombotic use was an independent risk factor for grade C PPH (p = .036). In the antithrombotic group, PPH tended to be delayed in the patients with restarting antithrombotic therapy. Notably, the occurrence of delayed PPH after restarting antithrombotic therapy was observed only when antithrombotic therapy was restarted within 10 days after pancreatectomy.
Conclusions
This multicenter study demonstrated that a history of antithrombotic use was a significant risk factor for PPH and mortality. In particular, the resumption of antithrombotic therapy in the early postoperative period should be done with caution.
CONFLICT OF INTEREST STATEMENT
This study was supported by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.
Supporting Information
| Filename | Description |
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| jhbp1349-sup-0001-TableS1.docxWord 2007 document , 15.3 KB |
Table S1 |
| jhbp1349-sup-0002-TableS2.docxWord 2007 document , 18.9 KB |
Table S2 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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