Study on Antithrombic Therapy During Emergency Laparoscopic Cholecystectomy

Continuing Antithrombic therapy (ATT) is safe during emergency laparoscopic cholecystectomy (LC) for acute cholecystitis (AC), according to a recent study published in the BMC Surgery.

Acute cholecystitis is inflammation of the gallbladder. It usually happens when a gallstone blocks the cystic duct. Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. Antithrombotic drugs in routine use include:

• Antiplatelet drugs (aspirin, clopidogrel, and glycoprotein IIb/IIIa receptor antagonists)
• Anticoagulants (unfractionated and low molecular weight heparin, warfarin, and direct thrombin inhibitors)

Continuing antithrombic therapy (ATT) during surgery increases the risk of bleeding. However, it is difficult to discontinue antithrombic therapy (ATT) in emergency surgery. Therefore, the safety of emergency laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) is still unclear. We aimed to clarify the effect of antithrombic therapy (ATT) during emergency LC for AC.

Patients with AC were classified into:

• Antithrombic therapy (ATT) group (n = 30)
• Non-antithrombic therapy (ATT) group (n = 120)

Postoperative outcomes were compared after propensity score matching (n = 22).

Results of the Study

A higher level of c-reactive protein level and shorter activated partial thromboplastin time (APTT) was observed in the antithrombic therapy (ATT) group than in the non-antithrombic therapy (ATT) group after matching. No significant difference was found between other patient characteristics and perioperative results. Blood loss over 100 mL was observed in 8 patients. Multivariate analysis showed that APTT was an independent risk factor for bleeding over 100 mL (P = 0.039), while ACT and APT were not.

Thus, the researchers concluded that taking antithrombic therapy (ATT) does not affect the blood loss or complications during emergency laparoscopic cholecystectomy (LC) for AC. Controlling intraoperative bleeding is essential for a safe postoperative outcome.

Reference

Taking antithrombic therapy during emergency laparoscopic cholecystectomy for acute cholecystitis does not affect the postoperative outcomes: a propensity score-matched study by Kentaro Oji, et al. published in the BMC Surgery.

Read the full study