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. 2025 Apr 15;17(4):e82287.
doi: 10.7759/cureus.82287. eCollection 2025 Apr.

Safety of Laparoscopic Hernia Surgery in Patients With Preoperative Antiplatelet Continuation Therapy

Keiji Nagata  1 , Takahisa Fujikawa  1
Affiliations

Safety of Laparoscopic Hernia Surgery in Patients With Preoperative Antiplatelet Continuation Therapy

Keiji Nagata et al. Cureus. .

Abstract

Introduction The optimal perioperative antithrombotic management of patients receiving antithrombotic therapy (ATT) remains controversial. In this study, we investigated the safety and feasibility of laparoscopic hernia surgery in patients taking ATT, especially those with a preoperative continuation of single antiplatelet therapy (APT). Methods Three hundred ninety-six (396) patients who underwent laparoscopic hernia surgery between April 2014 and March 2023 in our institution were retrospectively reviewed. The patients were divided into two groups: patients who continued single aspirin monotherapy preoperatively (continued single aspirin therapy (cAPT) group; n = 118) and patients who did not receive APT preoperatively (non-APT group; n = 278). Our perioperative antithrombotic management included preoperative continuation of single aspirin therapy for patients with APT or interruption of oral anticoagulation therapy (ACT), bridging anticoagulation with unfractionated heparin or direct-acting oral anticoagulants (DOAC) replacement for patients with ACT. The primary outcome was postoperative bleeding complications (BC). Results There were four postoperative BCs (Clavien-Dindo classification ≧ Ⅱ) (1.0%) in the whole cohort, one (0.9%) in the cAPT group, and three (1.1%) in the non-APT group, which were not significantly differentiated (p = 0.8330). Multivariable analysis showed heparin or DOAC replacement was an independently and significantly risk factor for postoperative bleeding (p = 0.0029, odds ratio (OR) = 32.6). Continuation of preoperative aspirin was not a risk factor for postoperative BCs. No thromboembolic complications occurred in the whole cohort. Conclusion We can safely and feasibly perform laparoscopic hernia surgery under preoperative antithrombotic management, including the preoperative continuation of single aspirin therapy, without any increase in bleeding events. However, careful consideration is required for the patient who received heparin bridging or DOAC replacement.

Keywords: antiplatelet therapy; antithrombotic therapy; aspirin monotherapy; bleeding complications; perioperative management.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Kokura Memorial Hospital Clinical Research Ethics Committee issued approval 24062102. The Kokura Memorial Hospital Clinical Research Ethics Committee authorized the protocol of the current study (#24062102), which complied with the Declaration of Helsinki. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Flowchart of this study
A total of 396 patients who underwent laparoscopic hernia surgery were divided into two groups based on the status of preoperative APT. APT: antiplatelet therapy, cAPT: continued single aspirin therapy
Figure 2
Figure 2. Perioperative antithrombotic management protocol (“Kokura Protocol”) for patients with ATT in the case of elective surgery
ACT: anticoagulation therapy, APT: antiplatelet therapy, ATT: antithrombotic therapy, DAPT: dual antiplatelet therapy, DOAC: direct-acting oral anticoagulant, NVAF: nonvalvular atrial fibrillation, PDE: phosphodiesterase, POD: postoperative day
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References

    1. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Furie KL, Kasner SE, Adams RJ, et al. Stroke. 2011;42:227–276. - PubMed
    1. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Douketis JD, Berger PB, Dunn AS, Jaffer AK, Spyropoulos AC, Becker RC, Ansell J. Chest. 2008;133:299–339. - PubMed
    1. Incidence of death and acute myocardial infarction associated with stopping clopidogrel after acute coronary syndrome. Ho PM, Peterson ED, Wang L, et al. JAMA. 2008;299:532–539. - PubMed
    1. Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis. Ferrari E, Benhamou M, Cerboni P, Marcel B. J Am Coll Cardiol. 2005;45:456–459. - PubMed
    1. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Poldermans D, Bax JJ, Boersma E, et al. Eur Heart J. 2009;30:2769–2812. - PubMed

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