Antitrombotik tedavi alan hastalarda, acil gastrointestinal sistem cerrahisi güvenli midir?

AMAÇ: Antirombotik (antiagregan ve antikoagülan) ilaç kullanýmý tüm dünyada ve ülkemizde giderek artmaktadýr. Gastrointestinal sistem tümör cerrahisi yapýlan hastalarýn %12.6’sý çeþitli sebeplerden antitrombotik tedavi almakta olup, bu çalýþmada, elektif veya acil gastrointestinal tümör cerrahisinin doðru antitrombotik tedavi yönetimi ile güvenli bir þekilde uygulanabilirliðini göstermeyi hedefledik.
GEREÇ VE YÖNTEM: Gastrointestinal tümör cerrahisi planlanan, antitrombotik tedavi alan hastalarýn ameliyat öncesi tedavi yönetimi tedavisi kesilenler, köprüleme tedavisi uygulananlar ve tedavisi devam edenler olarak üç grupta incelendi. Tüm hastalara anti-embolik çorap ya da intermitan pnömotik kompresyon cihazý mekanik profilaksi olarak ameliyat öncesi ve ameliyat sonrasý olarak uygulandý. Clavien-Dindo postoperatif kompli-kasyon sýnýflamasý da kullanýlarak baþta ameliyat sonrasý kanama ve tromboemboli olmak üzere ameliyat sonrasý komplikasyonlar deðerlendirildi. BULGULAR: Antitrombotik tedavi alan, tedavisi kesilen ve köprüleme tedavisi altýnda cerrahi yapýlan hastalar karþýlaþtýrýldýðýnda, kanama komplikas-yonu açýsýndan üç grup arasýndan anlamlý fark bulunmadý.
TARTIÞMA: Klinik deneyimin yüksek olduðu tersiyer merkezlerde tromboembolik riski artýrmadan antitrombotik tedavi altýnda gastrointestinal sistem cerrahisi güvenli bir þekilde yapýlabilir.

Is emergency gastrointestinal system tumor surgery safe under treatment of antitrombotics?

BACKGROUND: The use of antitrombotic (antiaggregant and anticoagulant) drugs is increasing all over the world and in our coun-try. About 12.6% of patients who underwent gastrointestinal tumor surgery receive antitrombotic therapy for various reasons, and in this study, we aimed to demonstrate the safe feasibility of elective or emergency gastrointestinal tumor surgery with the correct perioperative antitrombotic therapy management.
METHODS: The patients who were planned for gastrointestinal tumor surgery under antitrombotic treatment were analyzed in three groups as those whose pre-operative treatment management treatment was discontinued, those who underwent bridging treat-ment, and those whose treatment continued. Anti-embolic stockings or intermittent pneumatic compression devices were applied to all patients preoperatively and postoperatively as mechanical prophylaxis. Post-operative complications, especially post-operative bleeding and thrombosis, were evaluated using the Clavien–Dindo post-operative complication classification.
RESULTS: When patients who were under antithrombotic therapy, whose therapy was discontinued, and who underwent surgery under bridging therapy, no significant difference was found between the three groups in terms of bleeding complications.
CONCLUSION: In tertiary centers with high clinical experience, elective and emergency gastrointestinal system tumour surgery can be safely performed under antitrombotic therapy without increasing the thromboembolic risk.