Management of acute cholecystitis in patients on anti-thrombotic therapy: A single center experience
Background: Acute cholecystitis in patients on anti-thrombotic therapy (ATT) presents a clinical dilemma at the intersection between conflicting guidelines, specifically between timing of early operative management (OM) versus time-to-reversal of certain ATT agents. With growing recognition that non...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | Surgery Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589845023000842 |
| _version_ | 1797398562307309568 |
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| author | Solomon Feuerwerker Ruja Kambli Diana Grinberg Ajai Malhotra Gary An |
| author_facet | Solomon Feuerwerker Ruja Kambli Diana Grinberg Ajai Malhotra Gary An |
| author_sort | Solomon Feuerwerker |
| collection | DOAJ |
| description | Background: Acute cholecystitis in patients on anti-thrombotic therapy (ATT) presents a clinical dilemma at the intersection between conflicting guidelines, specifically between timing of early operative management (OM) versus time-to-reversal of certain ATT agents. With growing recognition that nonoperative management (NOM) is associated with considerable morbidity, and evidence in the literature that early OM in patients on ATT is safe, we reviewed our own practice to examine how we addressed these conflicting guidelines. Materials and methods: We performed a retrospective review of patients with acute cholecystitis between December 2017 and March 2022. Patients were classified as ATT or non-ATT; ATT patients were subdivided into anticoagulation (AC) and antiplatelet (AP) groups. Rates of OM were compared. Results: 502 patients with acute cholecystitis were identified, 464 non-ATT and 38 ATT. 30 ATT patients were on AC, 7 on AP, and 1 on both. Non-ATT patients were significantly more likely to receive OM at index presentation compared to those on ATT: 89.9 % vs 63.2 % (p < 0.05). Subgroup analysis of the ATT group showed AP patients were significantly less likely to receive OM compared to those on AC, 12.5 % vs 77 % (p < 0.05). Conclusions: At our institution, patients on ATT were significantly less likely to undergo OM for acute cholecystitis compared with non-ATT patients. Those on AC received OM significantly more than patients on AP. Further study is needed to better define the management of this growing population so that acute cholecystitis guidelines might address this issue in the future. |
| first_indexed | 2024-03-09T01:27:16Z |
| format | Article |
| id | doaj.art-5f5bbabeed1a47c3a09e906d702fc842 |
| institution | Directory Open Access Journal |
| issn | 2589-8450 |
| language | English |
| last_indexed | 2024-03-09T01:27:16Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery Open Science |
| spelling | doaj.art-5f5bbabeed1a47c3a09e906d702fc8422023-12-10T06:17:05ZengElsevierSurgery Open Science2589-84502023-12-01169497Management of acute cholecystitis in patients on anti-thrombotic therapy: A single center experienceSolomon Feuerwerker0Ruja Kambli1Diana Grinberg2Ajai Malhotra3Gary An4Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA; Corresponding author.Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT 05405, USADepartment of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USADepartment of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USADepartment of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USABackground: Acute cholecystitis in patients on anti-thrombotic therapy (ATT) presents a clinical dilemma at the intersection between conflicting guidelines, specifically between timing of early operative management (OM) versus time-to-reversal of certain ATT agents. With growing recognition that nonoperative management (NOM) is associated with considerable morbidity, and evidence in the literature that early OM in patients on ATT is safe, we reviewed our own practice to examine how we addressed these conflicting guidelines. Materials and methods: We performed a retrospective review of patients with acute cholecystitis between December 2017 and March 2022. Patients were classified as ATT or non-ATT; ATT patients were subdivided into anticoagulation (AC) and antiplatelet (AP) groups. Rates of OM were compared. Results: 502 patients with acute cholecystitis were identified, 464 non-ATT and 38 ATT. 30 ATT patients were on AC, 7 on AP, and 1 on both. Non-ATT patients were significantly more likely to receive OM at index presentation compared to those on ATT: 89.9 % vs 63.2 % (p < 0.05). Subgroup analysis of the ATT group showed AP patients were significantly less likely to receive OM compared to those on AC, 12.5 % vs 77 % (p < 0.05). Conclusions: At our institution, patients on ATT were significantly less likely to undergo OM for acute cholecystitis compared with non-ATT patients. Those on AC received OM significantly more than patients on AP. Further study is needed to better define the management of this growing population so that acute cholecystitis guidelines might address this issue in the future.http://www.sciencedirect.com/science/article/pii/S2589845023000842Acute cholecystitisAntiplateletAnticoagulantPercutaneous cholecystostomyAntithrombotic therapyLaparoscopic cholecystectomy |
| spellingShingle | Solomon Feuerwerker Ruja Kambli Diana Grinberg Ajai Malhotra Gary An Management of acute cholecystitis in patients on anti-thrombotic therapy: A single center experience Surgery Open Science Acute cholecystitis Antiplatelet Anticoagulant Percutaneous cholecystostomy Antithrombotic therapy Laparoscopic cholecystectomy |
| title | Management of acute cholecystitis in patients on anti-thrombotic therapy: A single center experience |
| title_full | Management of acute cholecystitis in patients on anti-thrombotic therapy: A single center experience |
| title_fullStr | Management of acute cholecystitis in patients on anti-thrombotic therapy: A single center experience |
| title_full_unstemmed | Management of acute cholecystitis in patients on anti-thrombotic therapy: A single center experience |
| title_short | Management of acute cholecystitis in patients on anti-thrombotic therapy: A single center experience |
| title_sort | management of acute cholecystitis in patients on anti thrombotic therapy a single center experience |
| topic | Acute cholecystitis Antiplatelet Anticoagulant Percutaneous cholecystostomy Antithrombotic therapy Laparoscopic cholecystectomy |
| url | http://www.sciencedirect.com/science/article/pii/S2589845023000842 |
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