Clinical question: Does continuing antiplatelet therapy through noncardiac surgery increase the risk of postoperative blood transfusion or surgical reintervention for bleeding?
Background: Many prior studies have analyzed the risks and benefits of holding versus continuing antiplatelet therapy in the perioperative setting, but heterogeneity in outcome reporting has limited the ability to compare and contrast studies.
Study design: Meta-analysis.
Setting: Both domestic and international studies were included in the meta-analysis.
Synopsis: With a MEDLINE search, 37 studies with over 30,000 patients total were identified and included in the meta-analysis. Studies compared outcomes of transfusion and surgical reintervention for bleeding in patients receiving noncardiac surgery. Patients were either on no antiplatelet therapy, single therapy, or dual-antiplatelet therapy (DAPT). Relative risk of transfusion escalated in proportion to the amount of antiplatelet therapy; there was a 14% increased risk (95% confidence interval, 1.03-1.26) with aspirin over control and a 33% (95% CI, 1.15-1.55) increased risk with DAPT over control.
Risk of surgical reintervention for bleeding, however, was not increased above control whether on aspirin (relative risk, 0.96; 95% CI, 0.76-1.22), clopidogrel (RR, 1.84; 95% CI, 0.87-3.87), or DAPT (RR, 1.51; (95% CI, 0.92-2.49).
Bottom line: In noncardiac surgery, continuing aspirin or DAPT perioperatively increases the need for transfusion, but not the need for surgical reintervention for bleeding.
Citation: Columbo JA, Lambour AJ, Sundling RA, et. al. A meta-analysis of the impact of aspirin, clopidogrel, and dual-antiplatelet therapy on bleeding complications in noncardiac surgery. Ann Surg. 2017;20(20):1-9.
Dr. Portnoy is hospitalist and instructor of medicine, Icahn School of Medicine of the Mount Sinai Health System.