Risk of Neck Hematoma Following Thyroidectomy in Patients Taking Direct Oral Anticoagulants: A Propensity Score Matching Analysis from Nine High-Volume European Centers (RAGNO Study)

Gian Luigi Canu¹, Fabio Medas¹, Federico Cappellacci¹, Giulia Lanzolla², Leonardo Rossi³, Francesco Pennestrì^{4

5}, Giacomo Di Filippo⁶, Angeliki Chorti^{7

8}, Pierpaolo Gallucci⁴, Andrea De Palma³, Carlo Enrico Ambrosini³, Ioannis Pliakos^{7

8}, Moysis Moysidis^{7

8}, Valentine Luzuy-Guarnero⁹, Benoit Bédat⁹, Giulia Salvi¹⁰, Serena Elisa Tempera¹⁰, Giulia Carnassale¹¹, Amelia Mattia¹¹, Giovanni Lazzari⁶, Tommaso Guagni¹², Martina Izzo¹², Francesco Boi², Eleonora Morelli⁶, Francesco Feroci^{12

13}, Emanuela Traini¹¹, Pietro Princi^{10

14}, Marco Stefano Demarchi⁹, Theodosios Papavramidis^{7

8}, Marco Raffaelli^{4

5}, Gabriele Materazzi³, Carmela De Crea^{4

5}, Pietro Giorgio Calò¹, Ragno Study Collaborative Group

Affiliations

¹ Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, Italy.
² Endocrinology Unit, Department of Medical Sciences, University of Cagliari, 09042 Monserrato, Italy.
³ Endocrine Surgery Unit, University Hospital of Pisa, 56100 Pisa, Italy.
⁴ UOC di Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
⁵ Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
⁶ Endocrine Surgery Unit, Department of Surgery and Oncology, Verona University Hospital, 37124 Verona, Italy.
⁷ First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, 546 36 Thessaloniki, Greece.
⁸ Unit of Minimally Invasive Surgery, Euromedica Kyanous Stavros, 546 36 Thessaloniki, Greece.
⁹ Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland.
¹⁰ Multifunctional Center of Endocrine Surgery, Cristo Re Hospital, 00167 Rome, Italy.
¹¹ Endocrine Surgery Unity, San Carlo di Nancy Hospital-GVM Care and Research, 00165 Rome, Italy.
¹² Department of General Surgery, SS Cosma e Damiano Hospital, 51017 Pescia, Italy.
¹³ Department of General and Oncologic Surgery, Santo Stefano Hospital, 59100 Prato, Italy.
¹⁴ Unicamillus International Medical University, 00131 Rome, Italy.

PMID: 40429429
PMCID: PMC12112328
DOI: 10.3390/jcm14103435

Risk of Neck Hematoma Following Thyroidectomy in Patients Taking Direct Oral Anticoagulants: A Propensity Score Matching Analysis from Nine High-Volume European Centers (RAGNO Study)

Gian Luigi Canu et al. J Clin Med. 2025.

. 2025 May 14;14(10):3435.

doi: 10.3390/jcm14103435.

Authors

Affiliations

¹ Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, Italy.
² Endocrinology Unit, Department of Medical Sciences, University of Cagliari, 09042 Monserrato, Italy.
³ Endocrine Surgery Unit, University Hospital of Pisa, 56100 Pisa, Italy.
⁴ UOC di Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
⁵ Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell'Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
⁶ Endocrine Surgery Unit, Department of Surgery and Oncology, Verona University Hospital, 37124 Verona, Italy.
⁷ First Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, 546 36 Thessaloniki, Greece.
⁸ Unit of Minimally Invasive Surgery, Euromedica Kyanous Stavros, 546 36 Thessaloniki, Greece.
⁹ Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland.
¹⁰ Multifunctional Center of Endocrine Surgery, Cristo Re Hospital, 00167 Rome, Italy.
¹¹ Endocrine Surgery Unity, San Carlo di Nancy Hospital-GVM Care and Research, 00165 Rome, Italy.
¹² Department of General Surgery, SS Cosma e Damiano Hospital, 51017 Pescia, Italy.
¹³ Department of General and Oncologic Surgery, Santo Stefano Hospital, 59100 Prato, Italy.
¹⁴ Unicamillus International Medical University, 00131 Rome, Italy.

PMID: 40429429
PMCID: PMC12112328
DOI: 10.3390/jcm14103435

Abstract

Background: Postoperative neck hematoma is an infrequent but potentially fatal complication following thyroidectomy. The main aim of this study was to evaluate the impact of direct oral anticoagulants (DOACs) on the occurrence of this complication. Methods: Patients who underwent thyroidectomy between January 2020 and December 2022 in nine high-volume thyroid surgery centers in Europe were retrospectively evaluated. Based on taking direct oral anticoagulants, patients were divided into two groups: the DOAC Group and the Control Group. Propensity score matching 1:1 was performed between the two groups, which were then compared through a univariate analysis. Results: The total number of patients enrolled based on the inclusion/exclusion criteria was 8985. Following propensity score matching, the study population consisted of 316 patients: 158 in the DOAC Group and 158 in the Control Group. In the DOAC Group, the overall incidence of neck hematoma was 5.70% (4.43% for neck hematomas managed conservatively, and 1.27% for those that required surgical revision of hemostasis). No statistically significant difference was found between the two groups in terms of the incidence of this complication. Hospital readmission due to neck hematoma was not observed in any patient. No statistically significant difference was found between the two groups in terms of the timing of the onset of neck hematomas that required surgical revision of hemostasis. Conclusions: This study showed that direct oral anticoagulants, in the field of thyroid surgery, have no impact on the occurrence of postoperative neck hematoma. Therefore, based on our findings, it can be concluded that thyroidectomy can be safely performed in patients taking this class of drugs.

Keywords: DOACs; anticoagulants; bleeding; complications; direct oral anticoagulants; hemorrhage; neck hematoma; thyroid surgery; thyroidectomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**Figure 1**
Flowchart regarding the study population.

See this image and copyright information in PMC

References

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Grants and funding

CUPF53C22000750006/The European Union-NextGenerationEU through the Italian Ministry of University and Research under PNRR-M4C2-I1.3 Project PE_00000019 "HEAL ITALIA"

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Risk of Neck Hematoma Following Thyroidectomy in Patients Taking Direct Oral Anticoagulants: A Propensity Score Matching Analysis from Nine High-Volume European Centers (RAGNO Study)

Affiliations

Risk of Neck Hematoma Following Thyroidectomy in Patients Taking Direct Oral Anticoagulants: A Propensity Score Matching Analysis from Nine High-Volume European Centers (RAGNO Study)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources