New Study: Aspirin Can Be Used Safely Even During Major Pancreas Surgery To Prevent Heart Attacks And Strokes
August 07, 2013
Patients have, in the past, discontinued aspirin therapy before surgery to avoid bleeding, but this puts them at higher risk of heart attack and stroke. A new study, "Safety of perioperative aspirin therapy in pancreatic surgery," published in the journal Surgery by researchers at Thomas Jefferson University Hospitals demonstrates for the first time that patients undergoing major pancreas operations can continue taking aspirin through the morning of surgery with no increased risk of bleeding.
According to Charles J. Yeo, M.D. the senior author, "These data are compelling. The prior practice of instructing patients to stop their aspirin five to 10 days prior to surgery should be abandoned. It is safe to perform major pancreas surgery in patients taking aspirin, and stopping aspirin may be dangerous."
Aspirin therapy to prevent blood clots and heart attacks is common among patients being treated for pancreatic disorders—because many also suffer from cardiovascular disease, the number one cause of death in the United States. In fact, heart attacks and other cardiac events after major, non-cardiac surgery occur in up to eight percent of those at risk of cardiac disease. This is a high risk — but aspirin, the best therapy to reduce that risk, has been considered too dangerous to use until now.
Aspirin use reduces cardiac events by 7.2 percent within 30 days of surgery—but it was thought too dangerous to use because it could trigger bleeding connected to the surgery. Instead, the standard practice has called for discontinuing aspirin five to 10 days before elective pancreatic surgery.
In this study, the surgical team at Jefferson has shown for the first time that continuing aspirin through the morning of surgery for patients undergoing elective pancreatic surgery does not increase bleeding.
The retrospective study examined the records of 1,017 patients who underwent pancreatic surgery, of whom 289 (28.4 percent) were kept on aspirin through the morning of surgery. The estimated blood loss during surgery was similar between the two groups, aspirin versus no aspirin (median 400 mL vs. 400 mL, P = .661), as was the rate of blood transfusion any time during the index admission (29 percent vs. 26 percent, P = 0.37) and the postoperative duration of hospital stay (median 7 days vs. 6 days, P = .103).
In addition, the aspirin group had a slightly increased rate of cardiovascular complications (10.1 percent vs. 7.0 percent, P = .107), which may reﬂect the cardiovascular health problems that led to their physicians to recommend aspirin therapy in the first place. Rates of pancreatic ﬁstula (15.1 percent vs. 13.5 percent, P = .490) and hospital readmissions were similar (16.9 percent vs. 14.9 percent, P = .451) between the two groups.
"So, we have changed our practice for the better. We no longer instruct our patients to discontinue taking aspirin prior to these major pancreas operations," says Dr. Yeo.