The safe and risk assessment of perioperative antiplatelet and anticoagulation therapy in inguinal hernia repair, a systematic review

Abstract

Background: There is a lack of consensus on the continuation or cessation of perioperative antiplatelet and anticoagulation therapies in inguinal hernia repair, therefore, the local hospital protocols dealing with these agents vary. The aim of this study is to investigate the risk and safety of perioperative antiplatelet and anticoagulation therapies in patients undergoing elective inguinal hernia repair.

Methods: The major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies published through January 2019 were identified, using the keywords Aspirin, Clopidogrel, Warfarin, antiplatelet, anticoagulation, inguinal hernia repair, bleeding, hematoma, complications. All relevant articles and reference lists in these original studies were also obtained from the above databases.

Results: Thirteen articles were identified, ten studies reported the results of perioperative application of antiplatelet therapy during inguinal hernia repair, nine trials reported the outcomes perioperative use of anticoagulation therapy in inguinal hernia repair, and six articles reported the results of both agents. One study did not indicate the perioperative cessation or continuation of the corresponding agents. Cessation of antiplatelets was reported in three studies and continuation of antiplatelets was used in six studies, they all demonstrated similar incidence of the bleeding complications, as compared with controls. Continued perioperative anticoagulation with Warfarin was reported in six studies and Warfarin discontinuation 3 days prior to operation was examined in two studies, both reported similar postoperative bleeding-related complication rates providing international normalized ratio (INR) < 3, and the postoperative hematoma incidence increased in the condition of INR > 3.

Conclusion: Our results indicated that, for both open and laparoscopic inguinal hernia repair, there is no need to stop the antiplatelet therapy (Aspirin or Clopidogrel), and due to the limited evidence and the complexity of each patient' condition, the continuation or cessation of anticoagulation with Warfarin should be tailored on a case-by-case basis.

Keywords: Anticoagulation; Antiplatelet; Aspirin; Bleeding; Inguinal hernia repair; Warfarin.