Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2016

01-09-2016 | Endocrine Tumors

Antiplatelet and Anticoagulant Medications Significantly Increase the Risk of Postoperative Hematoma: Review of over 4500 Thyroid and Parathyroid Procedures

Authors: Sarah C. Oltmann, MD, Amal Y. Alhefdhi, MD, Mohammad H. Rajaei, MD, David F. Schneider, MD, MS, Rebecca S. Sippel, MD, FACS, Herbert Chen, MD, FACS

Published in: Annals of Surgical Oncology | Issue 9/2016

Login to get access

Abstract

Purpose

Antiplatelet and/or anticoagulant medication use is common. Abstinence a week before surgery may still result in altered hemostasis. The study aim was to report on perioperative antiplatelet and anticoagulant use in thyroidectomy and parathyroidectomy patients, and to determine the association with postoperative hematoma (POH) rates.

Methods

Retrospective review of a prospective endocrine surgery database was performed. Procedure extent was defined as unilateral, bilateral, or extensive. Antiplatelets were categorized as none, 325 mg aspirin (ASA), <325 mg ASA, clopidogrel, or other. Anticoagulants were categorized as none, oral, or injectable.

Results

A total of 4514 patients were identified. POH developed in 22 patients (0.5 %). Rates were similar between age, gender, and reoperative status. POH were seven times more common after thyroidectomy (0.8 vs. 0.1 %, p < 0.01). Unilateral procedures had lower POH rates than bilateral or extensive (0.1 vs. 0.9 vs. 0.8 %, p < 0.01). POH rates in patients receiving 325 mg ASA (0.8 %) or clopidogrel (2.2 %) were much higher than patients not receiving antiplatelets (0.5 %) or receiving <325 mg ASA (0.1 %, p = 0.04). Oral anticoagulants (2.2 %) and injectable anticoagulants (10.7 %) had much higher POH rates than patients not receiving anticoagulants (0.4 %, p < 0.01). Target organ, patient gender, procedure extent, antiplatelet use, and anticoagulant use were included on logistic regression to determine association with POH. Bilateral procedures, thyroidectomy, clopidogrel, oral, and injectable anticoagulants were all independently associated with POH.

Conclusions

POH occur more frequently after thyroidectomy and during bilateral procedures. Patients requiring clopidogrel or any anticoagulant coverage are at much higher risk for POH. These higher-risk patients should be considered for observation to ensure prompt POH recognition and intervention.
Appendix
Available only for authorised users
Literature
1.
1. Wang TS, Pasieka JL, Carty SE. Techniques of parathyroid exploration at North American endocrine surgery fellowship programs: what the next generation is being taught. Am J Surg. 2014;207:527–32.CrossRefPubMed
2.
Sun GH, DeMonner S, Davis MM. Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, 1996–2006. Thyroid. 2013;23:727–33.CrossRefPubMed
3.
Clark N, Schneider DF, Vrabec S, Bauer PS, Chen H, Sippel RS. Increased efficiency of endocrine procedures performed in an ambulatory operating room. J Surg Res. 2013;184:200–3.CrossRefPubMedPubMedCentral
4.
Mazeh H, Khan Q, Schneider DF, Schaefer S, Sippel RS, Chen H. Same-day thyroidectomy program: eligibility and safety evaluation. Surgery. 2012;152:1133–41.CrossRefPubMed
5.
Tuggle CT, Roman S, Udelsman R, Sosa JA. Same-day thyroidectomy: a review of practice patterns and outcomes for 1168 procedures in New York State. Ann Surg Oncol. 2011;18:1035–40.CrossRefPubMed
6.
Snyder SK, Hamid KS, Roberson CR, et al. Outpatient thyroidectomy is safe and reasonable: experience with more than 1,000 planned outpatient procedures. J Am Coll Surg. 2010;210:575–82, 582–4.
7.
Marino M, Spencer H, Hohmann S, Bodenner D, Stack BC Jr. Costs of outpatient thyroid surgery from the University HealthSystem Consortium (UHC) database. Otolaryngol Head Neck Surg. 2014;150:762–9.CrossRefPubMed
8.
Rutledge J, Siegel E, Belcher R, Bodenner D, Stack BC Jr. Barriers to same-day discharge of patients undergoing total and completion thyroidectomy. Otolaryngol Head Neck Surg. 2014;150:770–4.CrossRefPubMed
9.
Promberger R, Ott J, Kober F, et al. Risk factors for postoperative bleeding after thyroid surgery. Br J Surg. 2012;99:373–9.CrossRefPubMed
10.
Campbell MJ, McCoy KL, Shen WT, et al. A multi-institutional international study of risk factors for hematoma after thyroidectomy. Surgery. 2013;154:1283–9.CrossRefPubMed
11.
Dehal A, Abbas A, Hussain F, Johna S. Risk factors for neck hematoma after thyroid or parathyroid surgery: ten-year analysis of the nationwide inpatient sample database. Perm J. 2015;19:22–8.CrossRefPubMedPubMedCentral
12.
Robert-Ebadi H, Le Gal G, Righini M. Use of anticoagulants in elderly patients: practical recommendations. Clin Interv Aging. 2009;4:165–77.PubMedPubMedCentral
13.
Capodanno D, Angiolillo DJ. Management of antiplatelet therapy in patients with coronary artery disease requiring cardiac and noncardiac surgery. Circulation. 2013;128:2785–98.CrossRefPubMed
14.
Culkin DJ, Exaire EJ, Green D, et al. Anticoagulation and antiplatelet therapy in urological practice: ICUD/AUA review paper. J Urol. 2014;192:1026–34.CrossRefPubMed
15.
Iqbal CW, Cima RR, Pemberton JH. Bleeding and thromboembolic outcomes for patients on oral anticoagulation undergoing elective colon and rectal abdominal operations. J Gastrointest Surg. 2011;15:2016–22.CrossRefPubMed
16.
Kraft CT, Bellile E, Baker SR, Kim JC, Moyer JS. Anticoagulant complications in facial plastic and reconstructive surgery. JAMA Facial Plast Surg. 2015;17:103–7.CrossRefPubMed
17.
Torn M, Rosendaal FR. Oral anticoagulation in surgical procedures: risks and recommendations. Br J Haematol. 2003;123:676–82.CrossRefPubMed
18.
Burkey SH, van Heerden JA, Thompson GB, Grant CS, Schleck CD, Farley DR. Reexploration for symptomatic hematomas after cervical exploration. Surgery. 2001;130:914–20.CrossRefPubMed
19.
Calo PG, Erdas E, Medas F, et al. Late bleeding after total thyroidectomy: report of two cases occurring 13 days after operation. Clin Med Insights Case Rep. 2013;6:165–70.CrossRefPubMedPubMedCentral
20.
Abbas G, Dubner S, Heller KS. Re-operation for bleeding after thyroidectomy and parathyroidectomy. Head Neck. 2001;23:544–6.CrossRefPubMed
21.
Bergenfelz A, Jansson S, Kristoffersson A, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3660 patients. Langenbecks Arch Surg. 2008;393:667–73.CrossRefPubMed
22.
Lang BH, Yih PC, Lo CY. A review of risk factors and timing for postoperative hematoma after thyroidectomy: is outpatient thyroidectomy really safe? World J Surg. 2012;36:2497–502.CrossRefPubMedPubMedCentral
23.
Rosenbaum MA, Haridas M, McHenry CR. Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg. 2008;195:339–43.CrossRefPubMed
24.
Liu J, Li Z, Liu S, Wang X, Xu Z, Tang P. Risk factors for and occurrence of postoperative cervical hematoma after thyroid surgery: a single-institution study based on 5156 cases from the past 2 years. Head Neck. 2016;38:216–9.CrossRefPubMed
25.
Kandil E, Noureldine SI, Abbas A, Tufano RP. The impact of surgical volume on patient outcomes following thyroid surgery. Surgery. 2013;154:1346–52.CrossRefPubMed
26.
Stavrakis AI, Ituarte PH, Ko CY, Yeh MW. Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery. 2007;142:887–99.CrossRefPubMed
27.
Musunuru S, Schaefer S, Chen H. The use of the LigaSure for hemostasis during thyroid lobectomy. Am J Surg. 2008;195:382–4.CrossRefPubMed
28.
Zarebczan B, Mohanty D, Chen H. A comparison of the LigaSure and harmonic scalpel in thyroid surgery: a single institution review. Ann Surg Oncol. 2011;18:214–8.CrossRefPubMed
29.
Coiro S, Frattaroli FM, De Lucia F, et al. A comparison of the outcome using LigaSure small jaw and clamp-and-tie technique in thyroidectomy: a randomized single center study. Langenbecks Arch Surg. 2015;400:247–52.CrossRefPubMed
30.
Hwang SO, Jung JH, Park HY, Kim WW. A prospective, randomized study between the Small Jaw® and the Harmonic Focus® in open thyroidectomy. Otolaryngol Head Neck Surg. 2014;150:943–8.CrossRefPubMed
31.
Wright JD, Ananth CV, Lewin SN, et al. Patterns of use of hemostatic agents in patients undergoing major surgery. J Surg Res. 2014;186:458–66.CrossRefPubMed
32.
Docimo G, Tolone S, Ruggiero R, et al. Total thyroidectomy with harmonic scalpel combined to gelatin-thrombin matrix hemostatic agent: is it safe and effective? A single-center prospective study. Int J Surg. 2014;12(Suppl 1):S209–12.CrossRefPubMed
33.
Mohr TS, Brouse SD. Perioperative management of antiplatelet agents. Orthopedics. 2012;35:687–91.CrossRefPubMed
34.
Chu EW, Telem DA, Chernoguz A, Divino CM. Assessing the risk of clopidogrel-related bleeding complications in patients undergoing inguinal herniorrhaphy. Hernia. 2011;15:31–5.CrossRefPubMed
35.
Ercan M, Bostanci EB, Ozer I, et al. Postoperative hemorrhagic complications after elective laparoscopic cholecystectomy in patients receiving long-term anticoagulant therapy. Langenbecks Arch Surg. 2010;395:247–53.CrossRefPubMed
36.
Piątek B, Piwnik M, Podgórski M, Strzelczyk J. Anticoagulants as a risk factor in patients operated on for abdominal hernia. Pol Przegl Chir. 2014;86:263–7.PubMed
37.
Koc U, Bostanci EB, Karaman K, et al. Basic hemostatic parameters in patients with long-term oral anticoagulation undergoing cholecystectomy. J Laparoendosc Adv Surg Tech A. 2011;21:417–25.CrossRefPubMed
Metadata
Title
Antiplatelet and Anticoagulant Medications Significantly Increase the Risk of Postoperative Hematoma: Review of over 4500 Thyroid and Parathyroid Procedures
Authors
Sarah C. Oltmann, MD
Amal Y. Alhefdhi, MD
Mohammad H. Rajaei, MD
David F. Schneider, MD, MS
Rebecca S. Sippel, MD, FACS
Herbert Chen, MD, FACS
Publication date
01-09-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 9/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5241-0

Other articles of this Issue 9/2016

Annals of Surgical Oncology 9/2016 Go to the issue

Gynecologic Oncology

From Conventional Radiotracer Tc-99m with Blue Dye to Indocyanine Green Fluorescence: A Comparison of Methods Towards Optimization of Sentinel Lymph Node Mapping in Early Stage Cervical Cancer for a Laparoscopic Approach

Gynecologic Oncology

The Survival Rate and Surgical Morbidity of Abdominal Radical Trachelectomy Versus Abdominal Radical Hysterectomy for Stage IB1 Cervical Cancer

Breast Oncology

TARGIT-R (Retrospective): North American Experience with Intraoperative Radiation Using Low-Kilovoltage X-Rays for Breast Cancer

Breast Oncology

Additional Cavity Shaving at the Time of Breast-Conserving Surgery Enhances Accuracy of Margin Status Examination

Pancreatic Tumors

Intraoperative Fluid Resuscitation Strategies in Pancreatectomy: Results from 38 Hospitals in Michigan

Thoracic Oncology

A Role for Tumor Volume Assessment in Resectable Esophageal Cancer