Preoperative Aspirin Use May Not Increase Risk of Bleeding in Thyroid Surgery

Maintaining aspirin therapy until thyroid surgery, including for patients with thyroid cancer, may not increase the risk of intraoperative bleeding, according to a study published in JAMA Otolaryngology-Head & Neck Surgery.

Patients receiving antiplatelet therapy prior to undergoing otolaryngologic surgery must weigh discontinuing treatment and risking thromboembolic complications against continuing and risking intraoperative hemorrhage, but there is no consensus on the direction patients and surgeons should take.

For this retrospective study, the outcomes of 570 patients who underwent thyroid surgery, including patients with thyroid cancers (eg, papillary carcinoma, follicular carcinoma), were collected to evaluate the effect of antiplatelet therapy on outcomes. Patients receiving aspirin therapy were on average 14.4 years older than patients who were not, and had an absolute increase of 20.3% in African American patients.

Of the study patients, 106 were receiving aspirin at the time of surgery, and 464 were aspirin-naive.

Results showed that there were no statistically or clinically significant increases in blood loss during surgery associated with aspirin use. Further analysis revealed that there was a significant increase in total hematoma formation and no significant increase in recurrent laryngeal nerve injury in the aspirin cohort, but both findings were inconclusive. 

Even though the data suggests that aspirin therapy can be maintained prior to surgery without any increase in risk of bleeding, the authors concluded that “Further research with a larger sample size and more outcome events are required to make definitive conclusions regarding the association between aspirin use and complications, including hematoma and recurrent laryngeal nerve injury.”

Reference

Raggio BS, Barton BM, Kandil E, Friedlander PL. Association of continued preoperative aspirin use and bleeding complications in patients undergoing thyroid surgery [published online March 1, 2018]. JAMA Otolaryngol Head Neck Surg. doi: 10.1001/jamaoto.2017.3262