Antithrombotic prescriptions for many general surgery patients significantly increases the likelihood of post-operative bleeding complications

Abstract

Background: The investigators hypothesized that despite cessation recommendations for peri-operative antithrombotic management in the elective setting, the use of these drugs is likely associated with increased odds for bleeding complications.

Methods: Humana® insurance claims (22 million covered lives) from 2007 through 2017 were analyzed. Only patients undergoing elective general surgery procedures were included. Patient Safety Indicator 09 (PSI-09) coding for post-operative hemorrhage and hematoma were analyzed.

Results: Despite the existence of peri-operative management guidelines, patients prescribed antithrombotic agents were 2.3 times more likely to develop post-operative bleeding complications (OR: 2.3436, 95% CI: 2.2155-2.4792, P < 0.0001). Nearly all antithrombotics prescribed in the pre-operative period led to a two-fold increased likelihood of post-operative bleeding-the odds ratios of enoxaparin and rivaroxaban approached seven.

Conclusion: The data should remind surgeons to closely monitor the peri-operative management and post-operative course of patients pre-operatively prescribed antithrombotics-especially enoxaparin and rivaroxaban given the high risk of postoperative bleeding complications.

Keywords: Anticoagulation; Hematoma; Hemorrhage; Post-operative bleed.