Safety of elective laparoscopic cholecystectomy in patients with antiplatelet therapy: Lessons from more than 800 operations in a single tertiary referral institution

Introduction: The perioperative antiplatelet management of patients receiving antiplatelet therapy (APT) for elective laparoscopic cholecystectomy (LC) is still controversial. Methods: A total of 808 patients who underwent elective LC were reviewed. We classified patients in this cohort into three groups according to thromboembolic risks: patients with no thromboembolic risk (non-APT group, n = 653), patients with low thromboembolic risk (APT-LR group, n = 106), patients with high thromboembolic risk (APT-HR group, n = 49). Our perioperative management of patients with high thrombotic risks included preoperative continuation of single aspirin therapy and early postoperative reinstitution. We assessed intraoperative and postoperative bleeding/thrombotic events among three groups. Primary outcome measures were intraoperative bleeding complications (IBCs, blood loss 200 mL or more) and postoperative bleeding complications (PBCs), and the independent risk factors for increased IBC were determined by multivariate analysis. This study was approved by our institutional review board (#17011804). Results: In the current cohort, IBC occurred in 17 (2.1%) patients. Postoperatively, there were three PBCs (0.4%) and two thromboembolic complications (TCs, 0.2%), respectively. The occurrences of IBC and TC did not show any significant difference between the three groups, but PBC was more common in the APT-LR group (P = 0.022). Multivariate analysis showed that only chronic cholecystitis was the independent risk factor for IBC (P < 0.001, odds ratio = 12.355), but preoperative continuation of APT or multiple APT use did not affect IBC. Conclusion: We performed elective LC safely in patients receiving APT under rigorous perioperative management of APT. Continuation of aspirin monotherapy is considered in patients with APT during elective LC.