Patients may safely continue aspirin to the day of pancreas surgery

Patients undergoing major pancreas operations can continue taking aspirin through the morning of surgery with no increased risk of bleeding, a study found.

A retrospective study examined patients who underwent elective pancreatoduodenectomy, distal pancreatectomy or total pancreatectomy between October 2005 and February 2012. Of 1,017 patients, 289 (28.4%) remained on aspirin through the morning of surgery at Thomas Jefferson University Hospital in Philadelphia, a practice that has been advised at that facility since 2005. Results were published online first July 24 by Surgery.

For the aspirin and no-aspirin groups, rates were similar for estimated blood loss during surgery (median, 400 mL vs. 400 mL, P=0.661), blood transfusion any time during the index admission (29% vs. 26%, P=0.37) and the postoperative duration of hospital stay (median, 7 days vs. 6 days, P=0.103).

The aspirin group had a slightly increased rate of cardiovascular complications (10.1% vs. 7%, P=0.107), which researchers suggested may reflect the cardiovascular health problems that led to beginning aspirin therapy. Rates were similar between the two groups for pancreatic fistulae (15.1% vs. 13.5%, P=0.490) and hospital readmissions (16.9% vs. 14.9%, P=0.451).

Researchers noted that continuing aspirin should be an acceptable and preferable practice, especially in patients who would benefit from antiplatelet therapy. Previous research shows that the mean interval between aspirin discontinuation and acute cardiac events is 8.5±3.6 days. Patients who stop taking aspirin 7 to 10 days before invasive procedures could experience thrombosis exactly at the time of exposure of platelets to defects in the endothelium that stem from major surgery.

They wrote, “Despite many surgeons' fears that preoperative aspirin use increases bleeding, this study (among others in nonpancreatic surgery) shows that this apprehension appears unfounded.”